Article

OBJECTIVE: To analyse the incidence and factors related to the development and
clinical evolution of fractures in patients with traumatic spinal cord injury.
DESIGN: A retrospective 10-year follow-up study. SETTING: Neurorehabilitation
centre. SUBJECTS: Sixty-three patients (50M/13F) with a mean age of 36 +/- 20
years with recent traumatic spinal cord injury attended over a one-year period
(January to December 2000). MAIN MEASURES: Medical reports were reviewed,
evaluating risk factors for osteoporosis, fracture incidence during the 10 years
following spinal cord injury, severity (ASIA score) and level of spinal cord
injury (paraplegia/tetraplegia), type of lesion (spastic/flaccid), weight-bearing
standing activity, and the cause, location and evolution of the fracture.
RESULTS: Of the 129 patients attending during the study period, 75 had traumatic
spinal cord injury (7 died and 5 had no follow-up). Finally, 63 patients were
included. Fifty-four per cent had complete motor injury (ASIA A). Twenty-five per
cent of these patients developed fractures, with 2.9 fractures per 100
patient-years. The femur was the most frequent location of the fractures.
Fractures were observed 6.4 +/- 2.4 years after spinal cord injury (range 2-10
years), all in males. Most fractures (70%) were related to low-impact injuries.
Fifty per cent presented with associated clinical complications and only 20% of
the patients had received anti-osteoporotic treatment. Spinal cord injury
severity was the only risk factor for the development of fractures (complete
spinal cord injury (ASIA A)) (RR 4.043; 95% confidence interval (CI)
1.081-23.846, P = 0.037). CONCLUSION: The incidence of fractures after spinal
cord injury is high, with severity and time since spinal cord injury being the
main determinants for their development. Fractures were frequently associated
with clinical complications. However, the use of anti-osteoporotic treatment was
uncommon.

Langue : ANGLAIS