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

Abstract

To evaluate the management of lower extremity fractures in patients with spinal cord injury in a referent university center. Retrospective monocentric study carried out in patients with spinal cord injury cared for lower extremity fractures at a University Hospital of Nantes. 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/cm 2 at the right femoral neck (T-score: −3.3; Z-score: −2.6), 0.574 g/cm 2 at the left one (T-score: −3.4; Z-score: −2.8) and 1.07 g/cm 2 at the lumbar spine (T-score: −0.38; Z-score: −0.21). Onze patients were treated with bisphosphonate. 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.