Medico-surgical management of lower extremity fractures in patients with spinal cord injury: Assessment and advice based on a 10-year retrospective study carried out in a university hospital

• Published in: Annals of physical and rehabilitation medicine 2015-09, Vol.58, p.e20-e20
• Main Authors: Fouasson-Chailloux, A., Dr, Dauty, M., Dr, Le Fort, M., Dr, Dubois, C., Dr, Gouin, F., Prof, Maugars, Y., Prof, Perrouin-Verbe, B., Prof
• Format: Article
• Language: English
• Subjects: Absorptiometry; Bisphosphonate; Dual-energy X-ray; Internal Medicine; Lower extremity fractures; Osteoporosis; Physical Medicine and Rehabilitation; Spinal cord injury
• ISSN: 1877-0657; 1877-0665
• DOI: 10.1016/j.rehab.2015.07.052

Summary Objectives To evaluate the management of lower extremity fractures in patients with spinal cord injury in a referent university center. Patients and method Retrospective monocentric study carried out in patients with spinal cord injury cared for lower extremity fractures at a University Hospital of Nantes. Results In 10 years, 57 fracture events responsible for 61 fractures in 41 patients were managed. Average patient age was 50 years old (22–83), 73.3% of patients were AIS A. The median time to onset of the 1st fracture was 14.2years. The most common sites were distal femur (27.9%), distal (21.3%) and proximal tibia (16.4%). Fracture mechanism was wheelchair fall in 50% of cases. Surgery was carried out for 65.6% of the fractures. At least one medico-surgical complication occurred after 25% of surgical treatments and 57.1% of orthopedic treatments. Forty-two percent of the fracture events were followed by hospitalization. Douze patients had dual-energy X-ray absorptiometry performed at the lumbar spine and femoral necks. The average bone mineral density was 0.566 g/cm2 at the right femoral neck (T-score: −3.3; Z-score: −2.6), 0.574 g/cm2 at the left one (T-score: −3.4; Z-score: −2.8) and 1.07 g/cm2 at the lumbar spine (T-score: −0.38; Z-score: −0.21). Onze patients were treated with bisphosphonate. Discussion Lower extremity fractures occur close to the knee for low traumas. Surgery seems to provide fewer complications. For sub-lesional bone loss screening, a low bone mineral density is predictive of fractures. The best site of measurement is the distal femur because of reliability and reproducibility. The measurement on the lumbar spine is not recommended. Bisphosphonates have never shown efficacy for the reduction of the number of fractures but allow an increase of bone mineral density.