Article

OBJECTIVE: To assess the risks associated with surgical and nonsurgical care of
femur fractures in people with spinal cord injury (SCI). DESIGN: Retrospective
cohort study; an analysis of Veterans Affairs (VA) data from the National Patient
Care Database. SETTING: Administrative data from database. PARTICIPANTS: The
cohort was identified by searching the administrative data from fiscal years 2001
to 2006 for veterans with a femur fracture diagnosis using the International
Classification of Diseases, 9th Revision, Clinical Modification codes. This group
was subdivided into those with (n=396) and without (n=13,350) SCI and those
treated with and without surgical intervention. INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Rates of mortality and adverse events. RESULTS: The SCI
group was younger with more distal fractures than the non-SCI group. In the
non-SCI population, 78% of patients had associated surgical codes compared with
37% in the SCI population. There was higher mortality in the non-SCI group
treated nonoperatively. In the SCI population, there was no difference in
mortality between patients treated nonoperatively and operatively. Overall
adverse events were similar between groups except for pressure sores in the SCI
population, of which the nonoperative group had 20% and the operative had 7%.
Rates of surgical interventions for those with SCI varied greatly among VA
institutions. CONCLUSIONS: We found lower rates of surgical intervention in the
SCI population. Those with SCI who had surgery did not have increased mortality
or adverse events. Surgical treatment minimizes the risks of immobilization and
should be considered in appropriate SCI patients.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS