Background/Purpose:
Patients with a chronic spinal cord injury (SCI) develop osteoporosis and are at high risk for fracture. However, there is limited information on how these fractures are currently treated. The purpose of this report was to examine treatment modalities (surgical compared with nonsurgical) of incident appendicular fractures in men with a chronic SCI of traumatic etiology.
Methods:
Patients with a chronic spinal cord injury (SCI) develop osteoporosis and are at high risk for fracture. However, there is limited information on how these fractures are currently treated. The purpose of this report was to examine treatment modalities (surgical compared with nonsurgical) of incident appendicular fractures in men with a chronic SCI of traumatic etiology.
Results:
1453 male Veterans with 2464 incident fractures met inclusion criteria for the study. These fractures included 345 upper extremity fractures (ICD-9 codes 810.x-819.x), 1667 lower extremity fractures (ICD-9 codes 808.x, and 820.x-828.x) and 452 unspecified fractures (ICD-9 829.x). 875 patients (60%) sustained a single fracture, while the remainder had 2 or more fractures over the five year time period of the study. Only a minority of subjects (9.6%) were treated with surgical intervention, most commonly for hip fractures. Amputations accounted for 20.6% (32/155) of total surgical procedures, or 1.3% of all fractures. There were 20 above the knee amputations (AKAs), 6 below the knee amputations (BKAs), 4 occurring at other sites (foot, toe and finger) amputations, and 2 hip disarticulations one of which was associated with a femur fracture and the other a trochanteric hip fracture. Of the 32 amputations, 72% were done as delayed procedures.
Conclusion:
Current patterns of appendicular fracture treatment in SCI indicate that the majority of fractures are managed nonsurgically within the VA healthcare system. A substantial number of surgical procedures were amputations. Many amputations were delayed, suggesting that they may represent failures of initial nonsurgical fracture treatment. There is a critical need to prospectively address optimal treatment (nonsurgical vs. surgical) by fracture site in patients with SCI.
Acknowledgements:
This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and the Rheumatology Research Foundation, Ephraim P. Engleman Resident’s Preceptorship Award.
Disclaimer:
This work does not reflect the views of the Veterans Health Administration or the United States government.
Disclosure:
M. Bethel,
None;
L. Bailey,
None;
F. Weaver,
None;
B. Le,
None;
S. Burns,
None;
J. Svircev,
None;
M. Heggeness,
None;
L. Carbone,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/surgical-compared-with-nonsurgical-management-of-fractures-in-men-with-chronic-spinal-cord-injury/