Article

OBJECTIVES: To identify circumstances surrounding the onset of fracture and
common risk factors in persons with spinal cord injury (SCI) and to suggest an
alternative or complement to the pharmacologic approach by evaluating the need
for a prospective study based on the impact of a targeted therapeutic education
on risk management of fractures in this population. DESIGN: Retrospective study.
SETTING: Hospital and Rehabilitation Center Setting. PARTICIPANTS: Women (n=7)
and men (n=25; N=32; with >/=1 fracture after the initial SCI that occurred at
home or in a hospital setting; mean +/- SD age, 53+/-12y at the time of clinical
review) with bone mineral density (BMD) measurements. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: Demographics, main circumstances of onset, and
complications of fractures, as well as transversal bone mineral density
evaluation. RESULTS: Nine patients had more than 1 fracture and 23 patients had
only 1 fracture (total, 43 fractures; mean age at onset of fracture, 49+/-12y;
median time since injury, 13.9y; mean delay in diagnosis, 6.5+/-15d). Fractures
occurred mostly in the lower limbs. The circumstances of onset of these fractures
were different and very stereotyped. In 3 cases, no trauma was reported. The most
frequent mechanisms identified were forced maneuvers by the patient or a third
party and falls. In 10 cases, the fracture occurred during a wheelchair transfer
with forced maneuver or a fall from the wheelchair. Twenty-five patients were
confined to bed after the fracture (mean duration of bed confinement, 18+/-28d;
range, 0-120d). Postfracture follow-up showed that for 43 cases of fractures, 19
had at least 1 orthopedic complication, 15 had local complications, and 23 had
general complications. Patients (23 of 32) benefited from dual-energy X-ray
absorptiometry to assess BMD a few months or years after the fracture (mean
femoral neck BMD, 0.574+/-0.197g/cm(2); mean femoral neck T score, -3.8+/-1.5).
CONCLUSION: With this retrospective analysis of common risk factors and
circumstances of onset of secondary fractures, there is a clear future for a
prospective study to evaluate the impact of targeted therapeutic education on
risk factors for secondary fractures in patients with SCI.
CI - Copyright A(c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS