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

Abstract

Objective: Describe the incidence and distribution of appendicular fractures in a cohort of veterans with spinal cord injury (SCI). Design: Retrospective, observational study of fractures in veterans with a chronic traumatic SCI. Results: Male and female veterans sustained incident fractures with similar observed frequency (10.5% vs 11.5%). The majority of fractures occurred in the lower extremities for both men and women. In men, a complete extent of injury (compared to incomplete) was associated with 41% greater relative risk (RR) of incident fracture (RR 1.41, 95% confidence interval [1.17, 1.70]) among those with tetraplegia, but not paraplegia. Furthermore, many men (33.9%, n = 434) sustained multiple fractures over the course of the study. There were no differences in mortality between men who sustained a single fracture and those who had multiple fractures. Conclusions: The extent of injury may be an important predictor of fracture risk for male veterans with tetraplegia. Once a fracture occurs, male veterans with SCI appear to be at high risk for additional fractures.

The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury

“…Other lower extremity sites, including fractures of the talus [ 157 ] and calcaneus [ 158 ], have been reported to occur while using exoskeletons [ 159 ]. Upper extremity fractures are less common, with one study reporting that approximately 83% of all long bone fractures are in the lower and only 17% in the upper extremity, with the most common upper fracture site being the humerus [ 160 ]. The risk of mortality following a lower extremity fracture is greater in men older than 50 years of age (hazard ratio [HR] 3.42, 95% confidence interval [CI] 2.75–4.25), in men with motor complete injury (HR 3.13, 95% CI 2.19–4.45) and in men with a high Charlson Comorbidity Index [ 161 ].…”

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

“…In 2019, there were approximately 291 000 individuals living with spinal cord injury (SCI) in the United States 1 . Over time, immobilization and SCI‐specific biochemical, neurologic, and endocrine factors contribute to bone loss below the level of injury 2‐7 . Sublesional bone mineral density (BMD) loss results in frequent lower extremity (LE) fractures, with annual incidence of 2‐3 fractures/100 patient‐years, twice the rate in the non‐SCI population 8‐12 .…”

“…1 Over time, immobilization and SCI-specific biochemical, neurologic, and endocrine factors contribute to bone loss below the level of injury. [2][3][4][5][6][7] Sublesional bone mineral density (BMD) loss results in frequent lower extremity (LE) fractures, with annual incidence of 2-3 fractures/100 patient-years, twice the rate in the non-SCI population. [8][9][10][11][12] Fractures in the SCI population contribute to increased morbidity, mortality, and cost.…”

Wheelchair Mobility–Related Injuries Due to Inadvertent Lower Extremity Displacement on Footplates: Analysis of the FDA MAUDE Database From 2014 to 2018

“…Postfracture complication rates for individuals with SCI range from 16.7% to 63.2% 8,33 . In people with SCI and fractures, complications include delayed fracture healing or nonunion, infection, venous thrombosis, complex regional pain syndrome, pyelonephritis, and incident pressure injuries 8,11,12,32–34 …”

“…8,33 In people with SCI and fractures, complications include delayed fracture healing or nonunion, infection, venous thrombosis, complex regional pain syndrome, pyelonephritis, and incident pressure injuries. 8,11,12,[32][33][34] Databases focused on wheelchair safety and injuries exist, but most document fall-related injuries. The healthcare community currently lacks access to accurate reporting of the incidence, prevalence, and mechanism of nonfall-related injuries, particularly those related to inadvertent LE displacement on wheelchair footplates (ILED) during wheelchair mobility.…”