Risk Factors For Refracture Research Articles

Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Retrospective study. Department of Orthopedic, an affiliated hospital of a medical university. This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 - 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 - 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. The main limitation is the retrospective nature of this study. Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention.

Risk factors for refracture of the femoral shaft in children after removal of external fixation

BackgroundExternal fixation is the primary treatment option in children for femoral shaft fractures, such as open femoral or multiple fractures. One complication is refracture, which is the biggest limitation of fixation devices. This study aims to investigate the risk factors associated with refracture after the removal of external fixation devices and decrease the frequency of refracture.Materials and methodsRetrospectively reviewed clinical data of 165 patients treated at our hospital for fresh femoral shaft fractures with external fixation between May 2009 and February 2018 were included in this study. Patients with pathological fractures, fractures of the femoral neck, fractures that were fixed using plates or elastic stable intramedullary nailing, and old fractures, as well as those who underwent postoperative femoral surgery were excluded. Potential risk factors included: patient age, gender, and weight, fracture sides, open or closed fracture, fracture sites, reduction methods, operation time, perioperative bleeding, number and diameter of the screws, and immobilization time. These factors were identified by univariate and logistic regression analyses.ResultsFemoral shaft refracture developed in 24 patients. Univariate analysis revealed that refracture was not statistically significantly associated with any of the above factors, except AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) classification type 32-D/4.2 and L2/L3 ratio (L2, length of femur fixed by the two screws farthest from the fracture line; L3, the total length from the greater trochanter to the distal end of femur; P < 0.001 and P = 0.0141, respectively). Multivariate analysis showed that PCCF classification type 32-D/4.2 and L2/L3 ratio were also independent risk factors for femoral refracture.ConclusionsFemoral shaft refracture is relatively common in children treated with external fixation. Because of the limited number of cases in this study, we cautiously concluded that the PCCF classification type 32-D/4.2 and L2/L3 ratio were independent risk factors for femoral shaft refracture in these patients.Level of evidenceIV

Risk factors for refracture following primary osteoporotic vertebral compression fractures

Risk factors for refracture following primary osteoporotic vertebral compression fractures

Analysis of Clinical Risk Factors for Refracture in Osteoporosis

Objective: To observe and explore the clinical risk factors for refracture in patients with osteoporosis. Methods: A total of 32 patients with fractures and refractures after osteoporosis diagnosis from our hospital were enrolled from June to December 2018. The clinical situations of the two groups (fracture or refracture) were compared with particular regard for the main risk factors after fracture. Results: Through an analysis of the clinical data, we found that sex, age, time needed to stand from lying down, and low bone mineral density T-score are clinical risk factors for refracture. People of an older age, a bone mineral density T-score lower than normal, and females who require more time to stand from a lying down position have a higher risk of refracture. Conclusion: There a number of complex risk factors for refracture in elderly patients with osteoporosis. Early investigation and targeted preventive measures have great significance in reducing the incidence of refracture.

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

IntroductionThe purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature.Materials and methodsThis study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008–2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit.ResultsThe mean age at the start of treatment was 46.7 years (11–84 years). The mean follow-up period was 7 years (2–12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8–20.7 months). The rate of union maintained at the last follow-up visit was 95.1%.ConclusionsAll patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7–100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.

Risk factors for refracture after plate removal for midshaft clavicle fracture after bone union

BackgroundOpen reduction and internal fixation (ORIF) with plates and screws is one of the treatment options for clavicle fractures. However, an additional operation for implant removal after union of the fracture is commonly performed due to a high incidence of hardware irritation. Despite union of the fracture, a subsequent refracture might occur after removal of the implant which requires additional surgeries for fixation. This study aims to determine the risk factors associated with refracture of the clavicle after hardware removal.MethodsWe retrospectively reviewed the medical records of 278 patients that were diagnosed with a midshaft clavicle fracture (male 190; female 88) that had (1) undergone ORIF of the clavicle with plates and (2) received a second operation for removal of hardware after solid union of the fracture between 2010 and 2017. Their mean age was 40.1 ± 15.1 years, and mean interval from fixation to plate removal was 12.5 ± 7.5 months. The patients were then divided into two groups based on the presence of refracture (n = 20) or without refracture (n = 258). We analyzed patient demographics, interval between fixation and implant removal, fracture classification (AO/OTA, Robinson), fixation device, whether wires or interfragmentary screws were used, clavicular length, and bone diameter at the fracture site.ResultsThe overall refracture rate was 7.2%, and the mean interval between plate removal and refracture was 23.9 days. A multivariate analysis showed that female (adjusted odds ratio [aOR] 4.74; 95% CI 1.6–14.1) and body mass index [BMI] (for every 1-unit decrease, aOR 1.25; 95% CI 1.06–1.48) were risk factors for refracture. In women, BMI was the only risk factor. The optimal BMI cutoff value was 22.73. In a female patient with a lower BMI, the refracture rate was 29.8%.ConclusionsThere are no significant radiographic parameters associated with refracture. Routine plate removal in a female patient with a low BMI after bony union of a midshaft clavicle fracture is not recommended because of a high refracture rate.

Factors affecting Sandwich vertebral re-fracture after vertebral augmentation surgery for osteoporotic spine Sandwich fractures

Objective To investigate the risk factors affecting Sandwich vertebral re-fracture after vertebral augmentation surgery for osteoporotic spine Sandwich fractures. Methods A retrospective case control study was conducted on the clinical data of 90 patients with osteoporotic spine Sandwich fractures treated with vertebral augmentation surgery from January 2004 to December 2015. There were 26 males and 64 females, aged (69.9±7.4)years. The patients were divided into fracture group (n=15) and non fracture group (n=75) according to the incidence of re-fracture after operation during follow-up. Gender, age, height, weight, bone mineral density, cumulative number of cemented vertebrae, location of the Sandwich vertebrae in the thoracolumbar segment, the preoperative kyphosis angle of the Sandwich fracture segment, surgical approach, cement injection approach (unilateral or bilateral), cement injection volume, cement leakage between the Sandwich intervertebral spaces, the postoperative kyphosis angle of the Sandwich fracture segment, and follow-up duration were used as independent variables. Chi-square test and multivariate logistic regression analysis were used to analyze the risk factors of vertebral Sandwich fracture. Results There were 97 Sandwich vertebrae in 90 patients, and 226 fractured vertebrae were treated with initial intensive treatment. The mean follow-up was 18.1 months. There were no significant differences in gender, age, height, weight, cumulative number of cemented vertebrae, whether the Sandwich vertebrae was located at the thoracolumbar segment, the preoperative kyphosis angle of the Sandwich fracture segment, the cement injection approach (unilateral or bilateral), the volume of cement injection, and the cement leakage between the Sandwich intervertebral spaces (P>0.05). There were significant differences in bone mineral density, surgical approach, and postoperative kyphosis angle of the Sandwich fracture segment between the two groups (P<0.05). Further logistic regression analysis showed that bone mineral density ≤ 3.5 SD and segmental kyphosis (≥10°) were risk factors for Sandwich fracture (P<0.05). Conclusions The low bone mineral density (T value ≤-3.5 SD)and postoperative kyphotic angle (≥10°) are risk factors for re-fracture of Sandwich vertebrae. Vertebroplasty itself does not increase the risk of recurrent vertebral fractures. Key words: Spinal fractures; Osteoporosis; Cement augmentation

Risk factors related to refracture after union of congenital pseudarthrosis of the tibia with a combined surgical

Objective To explore the risk factors related to refracture after union of congenital pseudarthrosis of the tibia with a combined surgical, and to provide an important reference for clinical treatment. Methods From April 2007 to August 2011, 40 cases of congenital pseudarthrosis of the tibia (CPT) confirmed by the use of intramedullary nail combined Ilizarov external fixator treatment of bony union were obtained for retrospective analysis. There were 27 males and 13 females, and the average age was 3.6±2.7 years (ranged from 0.8 to 11.3 years), and the follow-up time are all over 36 months. Survival analysis were applied respectively on gender, whether the merger of neurofibromatosis type 1 (NF-1) and ankle joint, operative age, fibular status and the cross-sectional area ratio of healing site. Multifactorial Cox proportional hazards regression analysis was performed on the single factor with statistical significance. Results No significant inter-group differences existed in gender or whether combined NF-1. In operative age ≥3 years group whose refracture-free survival was significantly better than those 0.05). Conclusion The major risk factors for refracture after union of congenital tibia pseudarthrosis with the use of intramedullary nail combined Ilizarov external fixator are the smaller cross-sectional area of pseudarthrosis and with fibula pseudarthrosis. Key words: Pseudarthrosis; Tibia; Fracture fixation; Risk factors

Risk Factors of Refracture and Morbidity During Removal of Titanium Pediatric Proximal Femoral Locking Plates in Children With Cerebral Palsy.

Pediatric proximal femoral locking plates (PFLPs) are widely used when performing proximal femoral osteotomy in children with cerebral palsy (CP). The purpose of this study is to report the difficulties and risk factors of titanium PFLPs removal in CP. PFLP removal was performed in 58 hips of 33 patients (17 males, 16 females). The mean age at the time of surgery (plate removal) was 10.9 (range, 5.7 to 19.2) years. The patients were divided into 2 groups as group 1 and 2, if any difficulty was observed during surgery or not. Difficulty was not detected in 42 (72.4%) hips (group 1). Difficulties were encountered in 16 (27.6%) hips (group 2). A total of 364 screws were used (259 in group 1, 105 in group 2). The mean plate screw density ratios were 0.88 in group 1 and 0.94 in group 2. The difference between group 1 and 2 was statistically significant. The mean duration between the insertion and removal of the PFLP was 14.9 months (11.9 mo in group 1, 22.7 mo in group 2). The difference between group 1 and 2 was statistically significant. The screw heads were cut and the shafts were left in the bone in 4 hips (4 screws); 3 of these 4 screws were calcar screws. Therefore, calcar screw application can be accepted as a handicap for screw removal. As a conclusion, this study suggested that difficulty in titanium PFLP removal in CP is common and PFLP removal is not a harmless procedure. A longer time from internal fixation to removal, increased plate screw density ratio, and calcar screw application are risk factors for difficulties in titanium PFLP removal in CP. Level III.

Risk factors for re-fracture in children with diaphyseal fracture of the forearm treated with elastic stable intramedullary nailing.

A retrospective study aims to investigate predisposing factors leading to re-fracture in patients with nails still in place and to identify potential correlations between nail size-to-medullary canal diameter ratio and re-fracture, working to the hypothesis that a higher ratio correlates with a higher risk of re-fracture. Rates of re-fracture with nail still in place after forearm elastic stable intramedullary nailing are higher in younger pediatric patients. Re-fractures occurred at a mean age of 6.7 years (range 5-8.7). While the role of body frame and bone medullary diameter remains unclear, there are grounds for adjusting treatment strategy for age, weight and bone medullary diameter to achieve effective outcome. History of previous forearm fracture and open treatment may also be further risk factors.

Influencing factors of refractures of the contralateral hip in elderly patients with hip fracture

Objective To study risk factors of refractures of the contralateral hip in elderly patients with hip fracture. Methods A retrospective study was conducted of the 419 elderly patients with hip fracture who had been treated at our department from April 2008 through December 2013. They were 178 males and 241 females, 61 to 95 years of age (average, 72.5 years). There were 154 cases of femoral neck fracture and 265 cases of intertrochanteric fracture. The time from injury to operation ranged from 2 to 8 days (average, 4.4 days). They were divided into a refracture group and no-fracture group according to presence or absence of refracture of the contralateral hip after surgery. The 2 groups were compared in terms of gender, age, combined disease, fracture type, osteoporosis, time from injury to operation, and Harris score at the last follow-up. Factors with P<0.05 were analyzed by multivariate logistic regression. Results The incidence of refracture of the contralateral hip among the 419 patients was 8.4% (35/419). There were significant differences between the refracture group (n=35) and the no-fracture group (n=384) groups in age, primary fracture type, osteoporosis and combined disease (P 0.05). The multivariate logistic regression analysis showed that combined disease (OR=5.155), osteoporosis (OR=6.793) and age (OR=4.502) were the major risk factors for refracture of the contralateral hip (P<0.05). Conclusions Combined disease, osteoporosis and great age may be the major risks for refracture of the contralateral hip in elderly patients following the surgery for primary hip fracture. To prevent contralateral hip fracture, effective treatment of combined disease and osteoporosis is of great importance during the first 2 years after primary fracture surgery. Key words: Hip fractures; Risk factors; Clinical characteristics; Aged

Analysis on the risk factors of second fracture in fracture related to osteoporosis

Objective To explore the clinical characteristics and risk factors of re-fracture in patients suffering from osteoporosis-related fractures as well as effective interventions.Methods From January 2006 to January 2008,a total of 273 patients with osteoporosis-related fracture were entered in the study,including out-patients and in-patients who were over 50 years old.The patients were divided into fracture group(n=225)and re-fracture group(n=48).The re-fracture rate was followed up for 2 years,during which 11 patients developed re-fracture.General data including age and sex,fracture types,femoral neck bone mineral density(BMD)T-scores tested by dual-energy X-rays absorptiometry(DEXA),Charlson index,timeinterval between two fractures as well as mobility skill assessment were collected and analyzed.Results The average age at the first fracture was 67.7±8.5 years vs.72.7±9.5 years for the re-fracture cases.Female accounted for 70.2% of the fracture group and 77.1% of the re-fracture group.The most common re-fracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup.Risk factors for a second fracture in osteoporotic fractures patients include age(＞75 years,HR=1.23; ＞85years,HR=1.68),female sex(HR=1.36),prior vertebral fractures(HR=1.62),prior hip fractures(HR=1.27),BMD T-score＜-3.5(HR=1.38)and weakened motor skills(HR=1.27).The refracture rate in osteoporosis-related fractures was 4.9% followed up for 2 years.The second fracture happened 3.7 years after the first one on average.Conclusion The risks of second fracture among patients with initial brittle fracture are substantial.Mobility skill assessment is an important risk factor for osteoporosis fractures recurrence.There is adequate time between fracture and re-fracture for effective interventions to prevent or reduce the risks of refracture,especially for the old women with a vertebral or hip fracture.Medication,motor function rehabilitation and fall-down prevention training would be helpful. Key words: Osteoporosis; Fractures,bone; Risk assessment

Analysis on the risk factors of second fracture in osteoporosis-related fractures

Objective To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions. Methods From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged (67.7 ± 8.5) years, and 48 refracture cases, aged (72.7 ± 9.5) years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods. Results Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the follow-up. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (>75 years, HR=1.23, 95%CI 1.18-1.29; >85 years, HR=1.68,95% CI 1.60-1.76), female sex (HR=1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR= 1.62, 95%CI 1.01-2.07), prior hip fractures (UR=1.27, 95%CI 0.89-2.42), BMD T-score<−3.5 (UR=1.38, 95%CI 1.17-1.72) and weakened motor skills (HR=1.27,95%CI 1.09-1.40). Conclusions The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication, motor functional rehabilitation and fall-down prevention training are helpful.