Surgical Versus Nonsurgical Treatment of Femur Fractures in People With Spinal Cord Injury: An Administrative Analysis of Risks

Bishop, Julius A.; Suárez, Paola; DiPonio, Lisa; Ota, Doug; Curtin, Catherine

doi:10.1016/j.apmr.2013.07.024

Cited by 11 publications

(18 citation statements)

References 14 publications

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“…32 In addition, several studies have suggested that surgical treatment of fractures in SCI patients may expedite post-fracture mobilization. 26,32 Conversely, other reports 9,28,33,34 have found nonsurgical treatments to be effective.…”

Section: Discussionmentioning

confidence: 66%

“…First, both primary and secondary diagnostic codes were used (only 218 (32.4%) of the femur and hip fractures were classified as the primary diagnoses); second, inpatient and outpatient encounters with fracture codes were used; and last, only those with a traumatic etiology of SCI were included. In contrast, the series by Bishop et al 26 examined only inpatients with a primary diagnostic code for a fracture and included both traumatic and nontraumatic etiologies of an SCI. 26 The inclusion of nontraumatic SCI in this prior study 26 may partially account for the greater frequency of surgeries reported because it is possible that fractures in nontraumatic SCI may be managed more like those in the general population.…”

Section: Discussionmentioning

confidence: 94%

“…In contrast, the series by Bishop et al 26 examined only inpatients with a primary diagnostic code for a fracture and included both traumatic and nontraumatic etiologies of an SCI. 26 The inclusion of nontraumatic SCI in this prior study 26 may partially account for the greater frequency of surgeries reported because it is possible that fractures in nontraumatic SCI may be managed more like those in the general population.…”

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“…In another study of chronic SCI patients with femur and hip fractures by Bishop et al, 26 nonsurgical treatments were also more commonly done than surgical treatments for femur and hip fractures, although surgical treatments were more commonly reported (37% versus 9.4%) than in this cohort. The series described here differs from the Bishop report 26 in a number of important ways. First, both primary and secondary diagnostic codes were used (only 218 (32.4%) of the femur and hip fractures were classified as the primary diagnoses); second, inpatient and outpatient encounters with fracture codes were used; and last, only those with a traumatic etiology of SCI were included.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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

Huang

Weaver

Obremskey

et al. 2020

PM&R

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Objective To review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic spinal cord injury (SCI). Type Systematic review. Literature Survey Medline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, http://ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966, to March 1, 2019. Methodology Search was restricted to English language and adults (age ≥ 18 yr). Titles and abstracts were reviewed for relevance to study topics for inclusion. Case reports, reviews, non‐SCI population studies, and studies examining fractures at the time of acute SCI were excluded. References of included articles from the original search and task force and external submissions yielded two additional articles that were included in the review after voting by task force members. Data extraction was performed by four task force members using a data extraction form, glossary, and instructions created in Microsoft Excel. Quality assessment was performed by three methodologists using prespecified criteria. Synthesis Twenty‐three articles were included. Use of surgery to treat LE fractures in chronic SCI has increased, though nonoperative management was still more frequently reported. Regardless of type of management, amputations, nonunion/malunion, and pressure injuries were among the most commonly reported complications. Functional and quality of life outcomes were less frequently reported. Conclusions There is insufficient evidence to support operative versus nonoperative management as best practice for management of LE fracture of SCI. Existing literature was limited by small sample sizes, lack of randomization or matched study designs, significant heterogeneity in populations and treatment strategies studied, and variability in defining and reporting outcomes of interest. The field would benefit from future research to address study design issues and standardization of outcome reporting to facilitate comparison of outcomes of operative versus nonoperative management.

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Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study

et al. 2023

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Surgical Versus Nonsurgical Treatment of Femur Fractures in People With Spinal Cord Injury: An Administrative Analysis of Risks

Cited by 11 publications

References 14 publications

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

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

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

Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study

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