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Le B, Gonzalez B, Weaver F, Sinnott B, Ray C, Chu E, Premji S, Raiford M, Mayur O, Carbone L. Malunions following lower extremity fractures in veterans with a spinal cord injury/disorder. J Spinal Cord Med 2024; 47:293-299. [PMID: 36977321 PMCID: PMC10885743 DOI: 10.1080/10790268.2023.2188391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Nearly 50% of all persons with a spinal cord injury/disorder (SCI/D) will sustain an osteoporotic fracture sometime in their life, with lower extremity fractures being the most common. There are a number of complications that can occur post fracture, including fracture malunion. To date, there have been no dedicated investigations of malunions among persons with SCI/D. OBJECTIVES The primary objective of this study was to identify risk factors associated with fracture malunion among fracture-related (type of fracture, fracture location, initial fracture treatment) and SCI/D-related factors. Secondary objectives were to describe treatment of fracture malunions and complications following these malunions. METHODS Veterans with SCI/D with an incident lower extremity fracture and subsequent malunion from Fiscal Year (FY) 2005-2015 were selected from the Veteran Health Administration (VHA) databases using International Classification of Diseases, 9th edition (ICD-9) codes for lower extremity fractures and malunion. These fracture malunion cases underwent electronic health record (EHR) review to abstract information on potential risk factors, treatments and complications for malunion. Twenty-nine cases were identified with a fracture malunion with 28 of them successfully matched with Veterans with a lower extremity fracture during FY2005-FY2014 without a malunion (matched 1:4) based on having an outpatient utilization date of care within 30 days of the fracture case. There was trend towards more nonsurgical treatment in the malunion group (n = 27, 96.43%) compared to the control group (n = 101, 90.18%) (P = 0.05), though fracture treatment proved not to be not associated with developing a malunion in univariate logistic regression analyses (OR = 0.30; 95% CI: 0.08-1.09). In multivariate analyses, Veterans with tetraplegia were significantly less likely (approximately 3-fold) to have a fracture malunion (OR = 0.38; 95% CI: 0.14-0.93) compared to those with paraplegia. Fracture malunion was significantly less likely to occur for fractures of the ankle (OR = 0.02; 95% CI: 0-0.13) or the hip (OR = 0.15; 95% CI: 0.03-0.56) compared to femur fractures. Fracture malunions were rarely treated. The most common complications following malunions were pressure injuries (56.3%) followed by osteomyelitis (25.0%). CONCLUSIONS Persons with tetraplegia as well as fractures of the ankle and hip (compared to the femur) were less likely to develop a fracture malunion. Attention to prevention of avoidable pressure injuries following a fracture malunion is important.
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Affiliation(s)
- Brian Le
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
- Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Bridget Sinnott
- Department of Medicine, Division of Endocrinology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Elizabeth Chu
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Sara Premji
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Mattie Raiford
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Omkar Mayur
- Department of Medicine, Division of Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Laura Carbone
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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TERZİ E, BİLSEL N, KIVRAK A, DİNÇER R. COMPARISON OF SURGICAL RESULTS OF RETROGRADE INTRAMEDULLARY NAILING AND FIXING WITH PLATE SCREW IN SUPRACONDYLAR FEMUR FRACTURES. SDÜ TIP FAKÜLTESI DERGISI 2022; 29:284-290. [DOI: 10.17343/sdutfd.1055414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
Amaç
Erişkinlerde görülen suprakondiler femur kırıkları eklem
yüzeyini ilgilendiren veya ilgilendirmeyen kırıklar
olup farklı cerrahi tespit seçenekleri bulunmasına
rağmen, tedavisi kolay olmayan bir kırık çeşididir. Bu
kırıklarda yapılan plak uygulamalarında geniş insizyonlar
sebebiyle yumuşak doku ve periost canlılığı
korunamayıp kaynamama gibi sonuçlarla karşılaşıldığından
dolayı cerrahlar tarafından retrograd intramedullar
çivileme metoduna bir yönelim meydana
gelmiştir.
Gereç ve Yöntem
Çalışmamızda retrograd intrameduller çivileme ve
plak ile tespit edilen iki grup hastada karşılaştırma yapıldı.
2005-2016 tarihleri arasında kliniğimizde tedavi
olan 20 hasta çalışmaya dahil edildi, bu hastaların 11’i
plak ile 9’u ise retrograd çivi ile tedavi edildi. Bu hastalarda
subjektif memnuniyet derecesi ameliyat sonrası
VAS, HSS, Neer skorları, artroz gelişimi, kuadriseps
kası gücü, uyluk atrofisi ve kısalık açısından araştırıldı
ve karşılaştırıldı.
Bulgular
Yapılan karşılaştırmalarda her iki tedavi grubu arasında
memnuniyet derecesi postoperatif VAS, HSS,
Neer skorları, artroz gelişimi, kuadriseps kası gücü,
uyluk kas atrofisi ve kısalık açısından istatiksel olarak
anlamlı bir fark saptanmadı.
Sonuç
Suprakondiler femur kırıklarında plak-vida ile tedavi
ve retrograd çivileme yöntemleri güvenilir tedavi yöntemleridirler,
her iki yöntemin avantaj ve dezavantajları
mevcut olup uzun vadede değerlendirildiğinde her
iki yönteminde suprakondiler femur kırıkları tedavisinde
başarılı olduğunu söyleyebiliriz.
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Huang D, Weaver F, Obremskey WT, Ahn J, Peterson K, Anderson J, Veazie S, Carbone LD. Treatment of Lower Extremity Fractures in Chronic Spinal Cord Injury: A Systematic Review of the Literature. PM R 2020; 13:510-527. [PMID: 32500657 DOI: 10.1002/pmrj.12428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic spinal cord injury (SCI). TYPE: Systematic review. LITERATURE SURVEY Medline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966, to March 1, 2019. METHODOLOGY Search was restricted to English language and adults (age ≥ 18 yr). Titles and abstracts were reviewed for relevance to study topics for inclusion. Case reports, reviews, non-SCI population studies, and studies examining fractures at the time of acute SCI were excluded. References of included articles from the original search and task force and external submissions yielded two additional articles that were included in the review after voting by task force members. Data extraction was performed by four task force members using a data extraction form, glossary, and instructions created in Microsoft Excel. Quality assessment was performed by three methodologists using prespecified criteria. SYNTHESIS Twenty-three articles were included. Use of surgery to treat LE fractures in chronic SCI has increased, though nonoperative management was still more frequently reported. Regardless of type of management, amputations, nonunion/malunion, and pressure injuries were among the most commonly reported complications. Functional and quality of life outcomes were less frequently reported. CONCLUSIONS There is insufficient evidence to support operative versus nonoperative management as best practice for management of LE fracture of SCI. Existing literature was limited by small sample sizes, lack of randomization or matched study designs, significant heterogeneity in populations and treatment strategies studied, and variability in defining and reporting outcomes of interest. The field would benefit from future research to address study design issues and standardization of outcome reporting to facilitate comparison of outcomes of operative versus nonoperative management.
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Affiliation(s)
- Donna Huang
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Frances Weaver
- Health Services Research and Development, Department of Veterans' Affairs, Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - William T Obremskey
- Division of Orthopedic Trauma Research, Center for Musculoskeletal Research, Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jaimo Ahn
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Peterson
- Veterans' Affairs Evidence-Based Synthesis Program, Portland VA Healthcare System, Portland, OR, USA
| | - Johanna Anderson
- Veterans' Affairs Evidence-Based Synthesis Program, Portland VA Healthcare System, Portland, OR, USA
| | - Stephanie Veazie
- Veterans' Affairs Evidence-Based Synthesis Program, Portland VA Healthcare System, Portland, OR, USA
| | - Laura D Carbone
- Charlie Norwood VA Medical Center, Augusta, GA, USA.,Division of Rheumatology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Koong DP, Symes MJ, Sefton AK, Sivakumar BS, Ellis A. Management of lower limb fractures in patients with spinal cord injuries. ANZ J Surg 2020; 90:1743-1749. [PMID: 32356588 DOI: 10.1111/ans.15924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low-energy fractures of the lower limb in patients post spinal cord injury (SCI) present significant management challenges. This is the first Australian study to review the experience from a tertiary referral SCI centre and aims to identify trends and suggest therapeutic options. METHODS Retrospective review over a 5-year period in patients with SCI treated for a lower limb fragility fracture. Patient demographics, spinal injury severity scores, fracture characteristics and treatment were assessed. Time to union, length of stay and treatment-related complications were also examined. RESULTS A total of 38 SCI patients with 42 lower extremity fractures met inclusion criteria. Mean age was 55.7 years and mean duration post-SCI at fracture was 22.5 ± 12.7 years. The femur (73.8%) was more commonly fractured than the lower leg (26.2%), with extra-articular distal femoral fractures most prevalent (35.7%). A total of 25 (60%) fractures were managed operatively, and 17 (40%) non-operatively. The majority of femoral fractures were managed with intramedullary nailing. Tibial fractures were more commonly managed non-operatively. Eight cases (19.1%) experienced complications, with a significant difference between frequency of complications in non-operative (35.3%) and operative (8.0%) groups; P = 0.045. All fractures united except one; time to union was shorter in patients treated surgically (13.6 ± 6.4 weeks) compared to those managed non-operatively (19.1 ± 8.1 weeks). CONCLUSIONS Lower limb fragility fractures in patients with SCI can be managed successfully via either operative or non-operative measures. In this series, fewer complications and shorter time to union were found in patients managed operatively.
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Affiliation(s)
- Denis P Koong
- Department of Orthopaedics and Trauma, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael J Symes
- The Orthopaedic Research Institute and Department of Orthopaedic Surgery, St George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, New South Wales, Australia
| | - Andrew K Sefton
- Department of Orthopaedics and Trauma, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Brahman S Sivakumar
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia
| | - Andrew Ellis
- Department of Orthopaedics and Trauma, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Abstract
The AO classification system, used as a guide for modern fracture care and fixation, follows a basic philosophy of care that emphasizes early mobility and return to function. Lower extremity long-bone fractures in patients with spinal cord injury often are pathologic injuries that present unique challenges, to which the AO principles may not be entirely applicable. Optimal treatment achieves healing without affecting the functional level of the patient. These injuries often result from low-energy mechanisms in nonambulatory patients with osteopenic bone and a thin, insensate soft-tissue envelope. The complication rate can be high, and the outcomes can be catastrophic without proper care. Satisfactory results can be obtained through various methods of immobilization. Less frequently, internal fixation is applied. In certain cases, after discussion with the patient, amputation may be suitable. Prevention strategies aim to minimize bone loss and muscle atrophy.
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Surgical compared with nonsurgical management of fractures in male veterans with chronic spinal cord injury. Spinal Cord 2015; 53:402-7. [DOI: 10.1038/sc.2015.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 11/08/2022]
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Surgical Versus Nonsurgical Treatment of Femur Fractures in People With Spinal Cord Injury: An Administrative Analysis of Risks. Arch Phys Med Rehabil 2013; 94:2357-2364. [DOI: 10.1016/j.apmr.2013.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/17/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022]
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Sugi MT, Davidovitch R, Montero N, Nobel T, Egol KA. Treatment of lower-extremity long-bone fractures in active, nonambulatory, wheelchair-bound patients. Orthopedics 2012; 35:e1376-82. [PMID: 22955405 DOI: 10.3928/01477447-20120822-25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A retrospective review of surgically treated lower-extremity long-bone fractures in wheelchair-bound patients was conducted. Between October 2000 and July 2009, eleven lower-extremity fractures in 9 wheelchair-bound patients underwent surgical fixation. The Short Musculoskeletal Function Assessment, Short Form, and Spinal Cord Injury Quality of Life questionnaires were used to assess functional outcome. Mechanism of injury for all patients was a low-energy fall that occurred while transferring. Four patients who sustained a distal femur fracture, 1 patient who sustained a distal femur fracture and a subsequent proximal tibia fracture, and 1 patient who sustained a proximal third tibia shaft fracture underwent open reduction and internal fixation with plates and screws. Three patients with 4 midshaft tibia fractures underwent intramedullary nailing. At last follow-up, all 9 patients had returned to their baseline preoperative function. Quality of life was significantly higher (P<.01) than the Spinal Cord Injury Quality of Life questionnaire's reference score. Self-reported visual analog scale pain scores improved significantly from time of fracture to last follow-up (P=.02). All fractures achieved complete union, and no complications were reported. This study's findings demonstrate that operative treatment in active, wheelchair-bound patients can provide an improved quality of life postinjury and a rapid return to activities.
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Affiliation(s)
- Michelle T Sugi
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
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Han HS, Kim DH, Kang SB. The use of a ti-ni shape memory alloy ring bone fixator during the retrograde nailing of supracondylar femoral fractures. Knee Surg Relat Res 2011; 23:231-5. [PMID: 22570840 PMCID: PMC3341807 DOI: 10.5792/ksrr.2011.23.4.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 11/06/2011] [Accepted: 11/08/2011] [Indexed: 01/25/2023] Open
Abstract
Purpose To identify the effects of using a Ti-Ni shape memory alloy ring shaped bone fixator (SMA-rBF) during the retrograde nailing of supracondylar femoral fractures. Materials and Methods The authors reviewed 25 patients with a supracondylar femoral fracture treated by retrograde intramedullary nailing with or without SMA-rBF (group S, 12/25; group N, 13/25). Radiological measurements of angular deformity were performed and functional assessments were made using the Sanders grading system. Results All fractures healed after an average of 12.2 weeks (range, 9-15 weeks) in group N and after 11.6 weeks (range, 10-13 weeks) in group S (p=0.351). The mean angle of coronal angular deformity was valgus 0.8° (range, varus 2.3°-valgus 4.5°) in group N and valgus 0.7° (range, varus 1.0°-valgus 2.4°) in group S (p=0.892). The mean angle of sagittal angular deformity was 1.0° in extension (range, flexion 3.2°-extension 3.1°) in group N and 0° (range, flexion 2.1°-extension 1.2°) in group S (p=0.022). However, functional grading evaluations revealed no differences between the two groups. Conclusions When reduction of a distal femoral fracture with retrograde nailing was difficult additional mini-open reduction and fixation with a ring shaped SMA did not delay or prevent bony union and resulted in good postoperative alignment.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Parratte S, Bonnevialle P, Pietu G, Saragaglia D, Cherrier B, Lafosse JM. Primary total knee arthroplasty in the management of epiphyseal fracture around the knee. Orthop Traumatol Surg Res 2011; 97:S87-94. [PMID: 21802385 DOI: 10.1016/j.otsr.2011.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/19/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the past few years the use of arthroplasty was broadened to treating complex epiphyseal fractures at the shoulder and elbow joints. Similar trends to treat this type of fractures at the knee are less documented. Based on a multicenter retrospective series study, the aims of this work is to evaluate the short term clinical results of total knee prostheses in the management of comminuted epiphyseal fractures around the knee, to identify the technical issues and fine tune the indications. MATERIAL AND METHODS Following the initiative of the French Hip and Knee Society (SFHG) and the Traumatology Study Group (GETRAUM), 26 charts from eight different centers in France were included in this multicenter retrospective series. Inclusion criteria were: primary total knee arthroplasty (TKA) in the management of complex articular fractures involving the proximal end of the tibia or distal end of the femur. Surgical features were identified and complications were analyzed. The assessment protocol at last follow-up was standardized and included patient demographic data, analysis of the Parker and IKS scores. RESULTS During the immediate postoperative period, six patients (23%) reported a general complication and four patients (15%) a local arthroplasty-related complication. At last follow-up (mean 16.2 months), the overall final Parker score was 6.3 (a mean decrease of 1.7) and the mean IKS knee score was 82 points for a mean function score of 54 points. DISCUSSION Primary TKA is a suitable management option for complex fractures in autonomous elderly patients suffering from knee osteoarthritis. The key technical details of this procedure should be respected and meticulously planned to achieve optimal results and limit the risk of complications. This risk in these acute complex fractures remains higher than after conventional TKA but comparable to that observed after TKA for post-traumatic arthritis. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- S Parratte
- Orthopaedic and Arthritis Surgery Center, Surgical Center for Osteoarthritis treatment, Pr Argenson's Department, St Marguerite Hospital, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
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