Associated injuries in patients with spinal injury

Silver, Jonathan; Morris, William R.; Otfinowski, J

doi:10.1016/0020-1383(80)90011-x

Cited by 56 publications

(18 citation statements)

References 6 publications

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“…In a study of associated injuries, 1 Silver and colleagues found that 27 out of 100 acute SCI patients had concurrent fractures, with most of them involving ribs, sternum, and clavicle, which was consistent with our ®ndings. The frequency of multiple fractures, nevertheless, was higher in Silver's series (20 out of 27), which might be partly explained by the di erence in the de®nition of multiple fractures.…”

Section: Discussionsupporting

confidence: 90%

“…Extraspinal fracture is one of the common associated injuries with SCI. 1,2 Fractures of face or mandible may be accompanied by head injury; fractures of ribs or pelvis may relate to internal visceral organs injury, which can lead to critical or fatal complications. 3 Fractures of long bones may be associated with peripheral nerve injury, compartment syndrome, malunion, nonunion, or deformity, which could delay functional recovery and increase impairment.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of extraspinal fractures associated with acute spinal cord injury

et al. 2001

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Study design: A descriptive study of concurrent extraspinal fractures collected prospectively during initial hospital care. Objectives: To examine the frequency and related characteristics of concurrent extraspinal fractures among patients with a new onset of spinal cord injury (SCI). Setting: Model SCI care systems throughout the United States. Methods: A consecutive sample of 5711 subjects admitted to the National SCI Database between 1986 ± 1995 was recruited to estimate the incidence of extraspinal fractures associated with acute SCI, strati®ed by anatomic sites, demographics, and injury related characteristics. Results: Of 5711 subjects, 1585 (28%) patients had extraspinal fractures; 580 (37%) patients had more than one fracture site. The most common region of fractures was chest, followed by lower extremity, upper extremity, head, others, and pelvis. The overall incidence rate was higher for women than men, for whites than non-whites, for paraplegics than tetraplegics, and for those injured in motor vehicle crashes than others. Compared with patients having single fracture, those who had multiple fractures were likely to be white, paraplegic, and injured in motor vehicle crashes. There was no age di erence in the incidence of concurrent fractures, single or multiple. Conclusions: Extraspinal fractures are not uncommon at the same time as SCI. The fracture occurrence varies by gender, race, injury level, and etiology of injury. The knowledge of these associated factors will aid in early recognition of fractures, preventing complications, and facilitating rapid mobilization and rehabilitation outcomes among persons with SCI. Spinal Cord (2001) 39, 589 ± 594

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Epidemiology of extraspinal fractures associated with acute spinal cord injury

et al. 2001

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“…Patients with spine fractures have a reported DVT incidence of 18 to 90% ( Table 2). The low incidence rate of 18% reported by Silver and colleagues [14] was probably due to empiric prophylactic anticoagulation in 68% of patients. In spite of anticoagulation DVT developed in 8 patients (12%).…”

Section: Incidencementioning

confidence: 94%

“…In spite of this, there are very few studies describing the true incidence or natural history of DVT in the trauma patient. Our review of the literature yielded only eight reports [3,4,[13][14][15][16][17][18] in which the diagnosis of DVT was firmly established in the trauma patient, by either autopsy examination or venogram ( Table 1). …”

Section: Incidencementioning

confidence: 99%

Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients

Shackford

Moser

1988

J Intensive Care Med

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Trauma patients are at exceedingly high risk for the development of deep venous thrombosis and pulmonary embolism. The incidence, pathophysiology, diagnosis, prophylaxis, and therapy of deep venous thrombosis and pulmonary embolism in the trauma patient are reviewed. The type of injury, systemic pertubations, and enforced immobility are important factors in pathogenesis. Patients with lower extremity injuries and spine fractures with paraplegia appear to be at highest risk. Orthopedic devices used to treat these injuries often preclude the conventional noninvasive diagnostic modalities. Further, hemorrhagic risk often impacts the judgment regarding the use of prophylactic measures as well as the therapy once deep venous thrombosis is diagnosed. Better data regarding the incidence of venous thromboembolism and the applicability of existing diagnostic, prophylactic, and treatment approaches in this population are needed. Accidents are responsible for over 140,000 deaths and approximately 70 million nonfatal injuries annually in the United States [1]. Most of the fatalities occur within hours of injury as a result of exsanguination or a lethal head injury, but approximately 20% survive for days or weeks [2], usually in the intensive care unit. The primary causes of late death are sepsis and multiple-organ failure [2]. Increasing evidence, however, suggests that pulmonary embolism (PE) is now becoming a leading cause of late death, especially in some high-risk groups [3][4][5].The increase in the incidence of PE is due in part to improvements in trauma care, which have lowered the early mortality rate [6-8], leaving more patients at risk for late death. In addition, autopsy examinations, used more frequently to audit trauma care systems [6,9], have documented an increase in clinically unsuspected deep venous thrombosis (DVT) and PE.This review was prompted because of the apparent increase in DVT and PE in the trauma population, and because the trauma patient presents very difficult and unique problems compared with the nontrauma patient with regard to the diagnosis, prophylaxis, and treatment of these disorders. In this review, we address the incidence, pathophysiology, diagnosis, treatment, and prophylaxis of DVT and PE in the trauma patient. We do not consider the entities of fat embolism or pulmonary microemboli as a cause of late pulmonary failure.

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“…(Silver, 1968, Frankel, 1968, Harris, 1968and Silver, Morris and Otfinowski, 1980. Untoward reaction to drugs can also lead to confusion as can withdrawal from alcohol, narcotic analgesics or psychotropic preparations.…”

Section: Discussionmentioning

confidence: 99%