Incidence, Epidemiology, and Occupational Outcomes of Thoracolumbar Fractures among U.S. Army Aviators

Belmont, Philip J.; Taylor, Kenneth F.; Mason, Kevin T.; Polly, David W.; Klemme, William R.

doi:10.1097/00005373-200105000-00013

Cited by 20 publications

(19 citation statements)

References 40 publications

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“…Overall SCI was approximately 18%, which is within the range reported for civilian trauma [27][28][29]. However, when fractures that are likely to produce SCI are reviewed, specifically Magerl A fractures, the rate of SCI is significantly higher than that reported in civilian trauma [17,[27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 58%

“…Unlike civilian trauma where falls from height are the most common or second most common MOI for blunt spinal trauma, it is relatively uncommon in combat at 10% in our series [27][28][29]. These increases may be multifactorial in nature such as changes in operational tempo, vehicle design, explosion type, and improved enemy tactics playing significant roles.…”

Section: Discussionmentioning

confidence: 81%

“…However, when fractures that are likely to produce SCI are reviewed, specifically Magerl A fractures, the rate of SCI is significantly higher than that reported in civilian trauma [17,[27][28][29][30][31]. Spinal cord injury was unchanged for M1 and M2.…”

Section: Discussionmentioning

confidence: 91%

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The effect of vehicle protection on spine injuries in military conflict

et al. 2012

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RESULTS:In total, 1,819 spine fractures occurred over the entire study period. Four hundred seventy-two fractures (26%) were sustained in 145 servicemembers who were mounted at the time of injury, and 1,347 (74%) were sustained by 404 servicemembers who were dismounted (p!.0005). The incidence of fractures in the dismounted cohort (D1þD2) was significantly higher than in the mounted cohort (M1þM2) The disclosure key can be found on the The spinal cord injury (SCI) incidence did not change in the mounted groups in Time Period 1 (7 of 71, 9.9%) versus Time Period 2 (7 of 74, 9.5%) (p5.935). In the dismounted groups, SCI actually decreased from D1 (55 of 228, 24%) to D2 (28 of 176, 16%) (p5.0428). CONCLUSIONS: The incidence of spine fractures and SCI is significantly higher in dismounted operations. The data suggest that current uparmored vehicles convey greater protection against spinal fracture compared with dismounted operations in which servicemembers are engaged on foot, outside their vehicles. The TL junction is at greatest risk for spine fractures sustained in mounted and dismounted combat operations. Recently, the incidence of TL fractures, especially severe fractures, has significantly increased in mounted operations. Although there has been an increased incidence of TL spine fractures, in context of the number of servicemembers deployed in support of Operation Enduring Freedom/Operation Iraqi Freedom, these severe fractures still represent a relatively rare event. Published by Elsevier Inc.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 81%

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The effect of vehicle protection on spine injuries in military conflict

et al. 2012

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“…29 Across published reports, the annual fracture incidence ranges from 23 to 90 per 100,000 people, and the age distribution is bimodal, with the first peak being found in young adults between 15 and 29 years of age and the second peak in adults older than 65 years. 3,4,10,12,[23][24][25]34,40 Factors that make the elderly more susceptible to these fractures include lower bone density, 20,43 alterations in vertebral biomechanics, 11,21 and more frequent falls. 38 In individuals ≥ 70 years, the annual fracture incidence exAbbreviAtioNs ARDS = acute respiratory distress syndrome; CCI = Charlson Comorbidity Index; ED = emergency department; GCS = Glasgow Coma Scale; HR = hazard ratio; ISS = Injury Severity Score; LOS = length of stay; NSP = National Sample Program; NTDB = National Trauma Data Bank; SBP = systolic blood pressure.…”

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confidence: 99%

Perioperative morbidity and mortality after lumbar trauma in the elderly

Winkler¹,

Yue²,

Birk³

et al. 2015

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OBJECT Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal trauma. Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. The authors sought to characterize the complications, morbidity, and mortality associated with surgical and nonsurgical management in elderly patients with traumatic fractures of the lumbar spine. METHODS Using the National Sample Program of the National Trauma Data Bank, the authors performed a retrospective analysis of patients ≥ 55 years of age who had traumatic fracture to the lumbar spine. This group was divided into middle-aged (55–69 years) and elderly (≥ 70 years) cohorts. Cohorts were subdivided into nonoperative, vertebroplasty or kyphoplasty, noninstrumented surgery, and instrumented surgery. Univariate and multivariable analyses were used to characterize and identify predictors of medical and surgical complications, mortality, hospital length of stay, ICU length of stay, number of days on ventilator, and hospital discharge in each subgroup. Adjusted odds ratios, mean differences, and associated 95% CIs were reported. Statistical significance was assessed at p < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS Between 2003 and 2012, 22,835 people met the inclusion criteria, which represents 94,103 incidents nationally. Analyses revealed a similar medical and surgical complication profile between age groups. The most prevalent medical complications were pneumonia (7.0%), acute respiratory distress syndrome (3.6%), and deep venous thrombosis (3%). Surgical site infections occurred in 6.3% of cases. Instrumented surgery was associated with the highest odds of each complication (p < 0.001). The inpatient mortality rate was 6.8% for all subjects. Multivariable analyses demonstrated that age ≥ 70 years was an independent predictor of mortality (OR 3.16, 95% CI 2.77–3.60), whereas instrumented surgery (multivariable OR 0.38, 95% CI 0.28–0.52) and vertebroplasty or kyphoplasty (OR 0.27, 95% CI 0.17–0.45) were associated with decreased odds of death. In surviving patients, both older age (OR 0.32, 95% CI 0.30–0.34) and instrumented fusion (OR 0.37, 95% CI 0.33–0.41) were associated with decreased odds of discharge to home. CONCLUSIONS The present study confirms that lumbar surgery in the elderly is associated with increased morbidity. In particular, instrumented fusion is associated with periprocedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is also associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings.

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“…4 In addition, the use of parachutes is itself associated with morbidity and mortality. [1][2][3]10 This is in part due to failure of the intervention. However, as with all interventions, parachutes are also associated with [atrogenic] complications.…”

Section: Discussionmentioning

confidence: 99%