Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2017.1329915 · Published: November 1, 2018

Spinal Cord Injury Musculoskeletal Medicine

Simple Explanation

This study examines lower extremity fractures in patients with spinal cord injuries (SCI), focusing on the characteristics, outcomes, and risk factors for non-union (failure of the fracture to heal). Sublesional osteoporosis, a common consequence of SCI, increases the risk of fractures and impairs bone healing. The study retrospectively analyzed data from 132 SCI patients with lower extremity fractures over an 11-year period. The researchers assessed demographic information, surgical and radiological outcomes, complication rates, union rates, and risk factors for non-union. The findings indicate that non-unions remain a common complication in SCI patients, even with modern surgical techniques. The study identified specific risk factors, such as fracture location, fracture classification, and fracture management, which contribute to the development of non-unions in this population.

Study Duration

11-year-period

Participants

132 patients with SCI suffering from osteoporotic/pathologic fractures

Evidence Level

Retrospective observational study

Key Findings

1
The study identified a non-union rate of 15.9% among SCI patients with lower extremity fractures.
2
Factors associated with the development of pseudarthrosis included the time interval since the initial SCI, delayed in-patient submission, fracture classification, and the localization of the fracture.
3
Independent predictors for non-unions were fracture localization, fracture classification, and fracture management.

Research Summary

This retrospective study analyzed 132 patients with spinal cord injury (SCI) who sustained lower extremity fractures over an 11-year period. The study aimed to identify demographic characteristics, outcomes, and risk factors for non-union in this population, given the high incidence of fractures and impaired bone healing due to sublesional osteoporosis after SCI. The results revealed a non-union rate of 15.9%. Factors such as the time since initial SCI, delayed hospitalization, fracture classification, and fracture location were associated with the development of pseudarthrosis. Independent predictors for non-union included fracture localization, fracture classification, and fracture management. The study concludes that even with modern surgical techniques, non-unions remain a common complication in patients with SCI. Identifying risk factors for non-unions of lower extremity fractures is crucial for improving outcomes in this population.

Practical Implications

Improved Fracture Management

The identification of risk factors allows clinicians to develop targeted strategies for managing lower extremity fractures in SCI patients.

Personalized Treatment Plans

Understanding the influence of fracture localization and classification enables tailored treatment approaches to minimize non-union risk.

Optimized Surgical Techniques

Recognizing the role of fracture management highlights the need for refining surgical techniques to enhance bone healing in patients with reduced mineral density.

Study Limitations

1
Data collected at a single center may limit generalizability.
2
Retrospective study design may result in missing values and incomplete datasets.
3
Relatively small sample size of patients suffering from pseudarthrosis may limit the strength of correlation analyses.

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