Limb fractures in patients with spinal cord injury

Freehafer, Alvin A.

doi:10.1016/s0003-9993(95)80546-x

Cited by 67 publications

(38 citation statements)

References 5 publications

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“…18 Fractures may occur in SCI with insigni®cant provocation, and are attributed to large BMC losses. 9,11 Reductions in hip region BMD were large, with the average femoral neck BMD being 74% that of agematched controls (LUNAR database). BeDell et al 29 (DEXA) found 79% BMD for the femoral neck in a group of paraplegics of similar duration of injury.…”

Section: Discussionmentioning

confidence: 99%

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

1998

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Persons with spinal cord injury lose lean tissue mass and bone but gain body fat. There is a need to quantify the magnitude of these changes in body composition because there are associated skeletal and cardiovascular health risks. We have compared total body and regional (lower limb) di erences in body composition in a group of males with paraplegia and in healthy able-bodied males matched for age, and height using dual energy X-ray absorptiometry. Although patients and controls had similar body mass indices, signi®cant reductions in lean tissue mass (16% less) and bone (12% less) were observed in those with spinal cord injury. Group di erences were even more pronounced in the lower limb. DEXA also revealed large increases in fat mass in subjects who did not look obese, total fat mass being 47% higher in the paraplegic group. We suggest that DEXA provides a simple and practical means to quantify both whole body and regional changes in body composition associated with spinal cord injury.

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Section: Discussionmentioning

confidence: 99%

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

1998

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“…Although the standard clinical protocol by DXA for assessing BMD involves the hip and spine, 8 it does not routinely measure the knee/leg where fractures are more likely to occur. [1][2][3][4][5] There have been some advances to refine the use of DXA at the distal femur and proximal tibia; Shields et al 14 have reported the reliability of a DXA protocol for assessment of BMD around the knee. Importantly, establishing normative data for BMD with a DXA-knee protocol is crucial for the future assessment of bone health for this population.…”

Section: Discussionmentioning

confidence: 99%

“…Bone health after a spinal cord injury (SCI) is an important issue that needs to be addressed because of an increased risk for fragility fractures [1][2][3][4][5] and the majority of these fractures occur during transfers or other activities that involve minimal or no trauma. 1 Contributing to the increased risk for fragility fracture is the loss of bone mineral density (BMD) in the lower extremity that was initially thought to stabilize around 1 year after injury 6 but below that of ablebodied peers.…”

Section: Introductionmentioning

confidence: 99%

Physiatrists' opinions and practice patterns for bone health after SCI

2008

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Study design: Self-report survey Objective: To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI). Participants: Physiatrists who work in teaching rehabilitation centers in Canada. Methods: A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers. Results: We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities. Conclusion: Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass. Spinal Cord IntroductionBone health after a spinal cord injury (SCI) is an important issue that needs to be addressed because of an increased risk for fragility fractures 1-5 and the majority of these fractures occur during transfers or other activities that involve minimal or no trauma. 1 Contributing to the increased risk for fragility fracture is the loss of bone mineral density (BMD) in the lower extremity that was initially thought to stabilize around 1 year after injury 6 but below that of ablebodied peers. More recent literature supports a continual loss of bone mass with time since injury suggesting that bone mineral loss continues 7 and contributes to the increased risk of fractures. In the general population, people who sustain a low-impact trauma fracture (falling from a standing height or less) have an increased risk for subsequent fracture, thus practice guidelines emphasize that these fragility fractures should prompt a workup to determine possible causes and appropriate management. 8 For people with SCI, previous literature suggests that the mean incidence of lower limb fracture is approximately 2% per year. 9 Yet despite these data there has been little published studies to highlight physiatrist practice patterns for bone health specifically for people with SCI.Prevention and treatment of osteoporosis following SCI has been investigated as early as a few days after the initial injury. 10 However, in practice, bone health interventions are generally initiated in the in-patient rehabilitation setting where physiatrists, specialists in rehabilitation medicine, are most often involved. In Canada, as advocated from best practice guidelines, people with SCI are treated in specialized rehabilitation centers that are teaching hospitals. After being discharged from rehabilitation and living in the community, bone health evaluation may involve the ongoing care by physiatrists and/or family physicians. Family physici...

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“…9 ± 13 In fractures of the lower extremities in chronic paraplegia or tetraplegia, however, conservative treatment is recommended. 5,8,11,14 The complication rate attributed to surgical therapy is too high. Defective alignment of the axis and leg shortening are accepted as unavoidable.…”

Section: Introductionmentioning

confidence: 99%

“…Defective alignment of the axis and leg shortening are accepted as unavoidable. 6,8,14 Even conservative treatment is not free of complications, however: complication rates of 19% and 42% have been reported. 11,15 The treatment selected for fractures of the lower extremities in the presence of chronic damage to the spinal cord should achieve secure primary stability and exclude the unnecessary risks inherent in open fracture treatment when the bone is a ected by osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients

et al. 2003

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Study design: Retrospective study. Objectives: To examine the value of operative fracture stabilization by means of the ring ®xator in fractures of the lower extremity in the presence of chronic paralysis caused by transverse lesions of the spinal cord. Setting: A specialist center for the treatment of spinal cord injuries in Germany. Methods: Clinical examination of the lower extremities with side-for-side comparison, radiological investigation of the fractures, patient survey. Patients: In 21 patients with chronic spinal cord lesions, 22 fractures of the lower extremities were treated with the ring ®xator. Results: At follow-up a mean of 41.5 months after fracture healing it could be shown that movement in the knee and ankle joints on the same side as the fracture was not restricted by more than 108 in any of our patients. No losses a ecting activities of daily living were reported, and 19 of the 21 patients were satis®ed with the result achieved with this technique. After four of the 22 operations there were complications. Malalignments were visible radiologically following ®ve of the fractures. Conclusions: In osteoporosis-induced fractures of the lower extremities in chronically paraplegic and tetraplegic patients, fracture stabilization with the ring ®xator, with fewer complications and better results in terms of joint mobility, is superior to the conservative treatment so far given preference in the literature. It should be o ered as an alternative to conservative treatment in the case of pathological fractures.

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Limb fractures in patients with spinal cord injury

Cited by 67 publications

References 5 publications

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

Physiatrists' opinions and practice patterns for bone health after SCI

Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients

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