Surgical compared with nonsurgical management of fractures in male veterans with chronic spinal cord injury

Abstract

Study design: Retrospective review of a clinical database. Objectives: To examine treatment modalities of incident appendicular fractures in men with chronic SCI and mortality outcomes by treatment modality. Setting: United States Veterans Health Administration Healthcare System. Methods: This was an observational study of 1979 incident fractures that occurred over 6 years among 12 162 male veterans with traumatic SCI of at least 2 years duration from the Veterans Health Administration (VA) Spinal Cord Dysfunction Registry. Treatment modalities were classified as surgical or nonsurgical treatment. Mortality outcomes at 1 year following the incident fracture were determined by treatment modality. Results: A total of 1281 male veterans with 1979 incident fractures met inclusion criteria for the study. These fractures included 345 (17.4%) upper-extremity fractures and 1634 (82.6%) lower-extremity fractures. A minority of patients (9.4%) were treated with surgery. Amputations and disarticulations accounted for 19.7% of all surgeries (1.3% of all fractures), and the majority of these were done more than 6 weeks following the incident fracture. There were no significant differences in mortality among men with fractures treated surgically compared with those treated nonsurgically. Conclusions: Currently, the majority of appendicular fractures in male patients with chronic SCI are managed nonsurgically within the VA health-care system. There is no difference in mortality by type of treatment.

Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions

“…7 A lot of fractures are managed conservatively. 15 But modern surgical techniques allow interventions in this patient cohort as well despite their reduced bone mineral density. However, this study identifies nonunions as a common complication in patients with SCI.…”

Treatment of Lower Extremity Fractures in Chronic Spinal Cord Injury: A Systematic Review of the Literature

“…For example, a patient chose an amputation after a femur fracture rather than undergo months of traction, whereas another patient who was medically managed developed gangrene requiring an above‐the‐knee amputation 11 . Bethel et al reported 25 LE amputations in 24/44 patients who were operatively managed in a retrospective analysis 34 . Cass reported three above‐the‐knee amputations in nine patients managed nonoperatively 35 .…”

A historical study of appendicular fractures in veterans with traumatic chronic spinal cord injury: 2002–2007

“…36 ASIA scores were not uniformly recorded in the time period of the study and thus were not included. Based on our previous work, 37 the development of HO following an incident fracture was exceedingly rare, therefore, we did not examine the association of HO with incident fracture. BMD was not included; it has been reported that low BMD is a predictor of the number of fractures in SCI.…”