Lukas Grassner1,2,3,4, Barbara Klein2,3, Doris Maier1, Volker Bühren1, Matthias Vogel1. 1. a Center for Spinal Cord Injuries, Trauma Center Murnau , Murnau , Germany. 2. b Institute of Molecular Regenerative Medicine , Paracelsus Medical University , Salzburg , Austria. 3. c Spinal Cord Injury and Tissue Regeneration Center Salzburg , Paracelsus Medical University , Salzburg , Austria. 4. d Department of Neurosurgery, Trauma Center Murnau , Murnau , Germany.
Abstract
CONTEXT: Sublesional osteoporosis is an important sequel after spinal cord injury (SCI) resulting in a high incidence of fractures and impaired osseous healing due to altered bone metabolism. The following study aims to identify demographic characteristics and outcome of patients with SCI with lower extremity fractures. DESIGN: Retrospective observational study. SETTING: Level-I cross-regional trauma center. PARTICIPANTS: All patients with SCI suffering from osteoporotic/pathologic fractures during an 11-year-period (01/2003-12/2013) at the Center for Spinal Cord Injuries (Trauma Center Murnau) were analyzed via a chart review. OUTCOME MEASURES: Demographics, surgical and radiologic outcome as well as complication rate were assessed with a special emphasis on union rates and independent risk factors for non-unions. RESULTS: We identified 132 patients (105 males) who fulfilled the inclusion criteria. Most of them were paraplegic (n=101) and showed motor complete syndromes (n=119). Supracondylar femur fractures were the most prevalent in this study (n=47). We observed a non-union rate of 15.9% (n=21). The development of pseudarthrosis was associated with the time interval since the initial SCI (P < 0.010), delayed in-patient submission (P < 0.038), fracture classification (P < 0.002) and the localization of the fracture (P < 0.0001). The overall complication rate was 16.7%. All dislocated subtrochanteric femur fractures (Garden III and IV) (n=10) developed a non-union, regardless of their management (conservative or surgical). The following independent predictors for non-unions were identified: fracture localization (P < 0.0002), fracture classification (P < 0.056), and fracture management (P < 0.036). CONCLUSIONS: Even though modern techniques allow surgical interventions in bones with reduced mineral density, non-unions remain a common complication in patients with SCI. Risk factors for non-unions of lower extremity fractures are identified.
CONTEXT: Sublesional osteoporosis is an important sequel after spinal cord injury (SCI) resulting in a high incidence of fractures and impaired osseous healing due to altered bone metabolism. The following study aims to identify demographic characteristics and outcome of patients with SCI with lower extremity fractures. DESIGN: Retrospective observational study. SETTING: Level-I cross-regional trauma center. PARTICIPANTS: All patients with SCI suffering from osteoporotic/pathologic fractures during an 11-year-period (01/2003-12/2013) at the Center for Spinal Cord Injuries (Trauma Center Murnau) were analyzed via a chart review. OUTCOME MEASURES: Demographics, surgical and radiologic outcome as well as complication rate were assessed with a special emphasis on union rates and independent risk factors for non-unions. RESULTS: We identified 132 patients (105 males) who fulfilled the inclusion criteria. Most of them were paraplegic (n=101) and showed motor complete syndromes (n=119). Supracondylar femur fractures were the most prevalent in this study (n=47). We observed a non-union rate of 15.9% (n=21). The development of pseudarthrosis was associated with the time interval since the initial SCI (P < 0.010), delayed in-patient submission (P < 0.038), fracture classification (P < 0.002) and the localization of the fracture (P < 0.0001). The overall complication rate was 16.7%. All dislocated subtrochanteric femur fractures (Garden III and IV) (n=10) developed a non-union, regardless of their management (conservative or surgical). The following independent predictors for non-unions were identified: fracture localization (P < 0.0002), fracture classification (P < 0.056), and fracture management (P < 0.036). CONCLUSIONS: Even though modern techniques allow surgical interventions in bones with reduced mineral density, non-unions remain a common complication in patients with SCI. Risk factors for non-unions of lower extremity fractures are identified.
Authors: Vassilios S Nikolaou; Nicolas Efstathopoulos; George Kontakis; Nikolaos K Kanakaris; Peter V Giannoudis Journal: Injury Date: 2009-03-25 Impact factor: 2.586
Authors: Marylou Guihan; Kayla Roddick; Tomas Cervinka; Cara Ray; Christopher Sutton; Laura Carbone; Frances M Weaver Journal: J Spinal Cord Med Date: 2021-03-11 Impact factor: 1.985
Authors: Bridget Sinnott; Cara Ray; Frances Weaver; Beverly Gonzalez; Elizabeth Chu; Sarah Premji; Mattie Raiford; Rachel Elam; Scott Miskevics; Stephen Parada; Laura Carbone Journal: JBMR Plus Date: 2022-01-05
Authors: Michelle A Tucci; Yilianys Pride; Suzanne Strickland; Susanna M Salazar Marocho; Ramon J Jackson; Joshua R Jefferson; Alejandro R Chade; Raymond J Grill; Bernadette E Grayson Journal: Neurotrauma Rep Date: 2021-06-22