Extremity Fractures of Patients with Spinal Cord Injuries

Comarr, Estin; Hutchinson, R.; Bors, Ernest

doi:10.1310/nj4c-4evm-3una-arkr

Cited by 38 publications

(44 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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: 95%

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

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 95%

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

et al. 2015

View full text Add to dashboard Cite

show abstract

“…13 One of the clinical effects of osteoporosis in paraplegia is spontaneous fracture of long bones. [14][15][16] The usual history of trauma and the classical signs of fracture are absent in these patients. Frequently, minor trauma is the cause of fracture.…”

Section: Introductionmentioning

confidence: 99%

Long-term changes in the tibia and radius bone mineral density following spinal cord injury

Bruin

Vanwanseele

et al. 2004

Spinal Cord

View full text Add to dashboard Cite

Design: A prospective inception cohort study with an observational analytic design in a spinal cord injury (SCI) centre hospital. Objective: To assess changes in trabecular and compact bone of the tibia and radius prospectively in subjects with SCI. Subjects: In total, 10 individuals with an acute SCI. Methods: Trabecular and compact bone density of the tibia and radius by peripheral quantitative computerised tomography. Results: Analysis of the individual gradients of the curve coefficient showed changes in trabecular bone between À0.19 and À2.46 and in cortical bone between þ 0.07 and À0.93 in the tibia within 34 months after the SCI. Both trabecular and cortical bone showed a group mean loss of 99 mg/cm 3 . No changes were observed in the radius. Conclusion: There is a major decrease in tibia mineral density over 3 years; however, no change is observed for the radius mineral content. Large interindividual differences existed in the patterns of loss in the tibia bone substance after SCI. These patterns indicate that there is no steady state of bone mineral density following 3 years of spinal cord injury.

show abstract

“…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%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Physiatrists' opinions and practice patterns for bone health after SCI

2008

View full text Add to dashboard Cite

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...

show abstract

Extremity Fractures of Patients with Spinal Cord Injuries

Cited by 38 publications

References 0 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

Long-term changes in the tibia and radius bone mineral density following spinal cord injury

Physiatrists' opinions and practice patterns for bone health after SCI

Contact Info

Product

Resources

About