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Morbidity following lower extremity fractures in men with spinal cord injury

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Abstract

Summary

The Veterans Affairs Spinal Cord Dysfunction Registry from 2002 to 2007 was reviewed to determine whether men with spinal cord injury (SCI) and lower extremity fractures had an increased risk of complications compared to those without fractures. We determined that fractures are associated with significant consequences, particularly during the first month postfracture.

Introduction

Despite increasing longevity, patients with SCI have a substantial number of illnesses and comorbid conditions. Lower extremity fractures are frequent events in these patients. However, whether these fractures are associated with any increased risk of complications in SCI is not certain. The purpose of this report was to determine the impact of lower extremity fractures on morbidities in men with SCI.

Methods

A population-based, nested, case–control (1,027 cases and 1,027 propensity-matched controls) of men enrolled in the Veterans Affairs Spinal Cord Dysfunction Registry from fiscal years 2002 to 2007 was reviewed to determine whether lower extremity fractures were associated with an increased risk for complications.

Results

In propensity score models matched for demographic (age, race) and SCI-related injury factors (level/completeness of SCI), Veterans Affairs-service connection status, and comorbidities, at 1 month following the fracture, there was an increased risk for respiratory infections, pressure ulcers, urinary tract infections, thromboembolic events, depression, and delirium (p ≤ 0.03 for all). Over 12 months, the only complication more common in fracture cases was pressure ulcers (p < 0.01), with an absolute difference of less than 2 % when compared to controls. There was no significant increased risk of cardiac arrhythmias at any time examined following fracture (≥0.12).

Conclusions

Lower extremity fractures are associated with significant consequences in men with SCI during the first month postfracture, but they do not persist for a long term, except for pressure ulcers. Targeted interventions to prevent complications should be considered following lower extremity fractures in SCI, particularly in the first month following fracture.

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Acknowledgments

This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development #IIR 08-033.

Conflicts of interest

None.

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Authors and Affiliations

  1. Veterans Affairs Medical Center, Memphis, TN, 38163, USA

    L. D. Carbone

  2. Department of Medicine, Division of Rheumatology, University of Tennessee Health Science Center, Memphis, TN, USA

    L. D. Carbone

  3. Edward J. Hines, Jr. VA Hospital, Hines, IL, USA

    A. S. Chin & F. Weaver

  4. VA Puget Sound Health Care System, Seattle, WA, USA

    S. P. Burns & J. N. Svircev

  5. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    S. P. Burns & J. N. Svircev

  6. Durham Veterans Affairs Medical Center, Durham, NC, USA

    H. Hoenig

  7. Veterans Affairs Medical Center, Houston, TX, USA

    M. Heggeness

  8. Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA

    M. Heggeness

  9. Stritch School of Medicine, Loyola University, Maywood, IL, USA

    F. Weaver

Authors
  1. L. D. Carbone
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  2. A. S. Chin
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  3. S. P. Burns
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  4. J. N. Svircev
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  5. H. Hoenig
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  6. M. Heggeness
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  7. F. Weaver
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Correspondence to L. D. Carbone.

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Carbone, L.D., Chin, A.S., Burns, S.P. et al. Morbidity following lower extremity fractures in men with spinal cord injury. Osteoporos Int 24, 2261–2267 (2013). https://doi.org/10.1007/s00198-013-2295-8

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  • DOI: https://doi.org/10.1007/s00198-013-2295-8

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