Session III - Hip / Femur

Fri., 10/11/13 Hip/Femur, PAPER #48, 10:27 am OTA 2013

Operative Versus Nonoperative Treatment of Femoral Fractures in Spinal Cord Injury Patients

Julius A. Bishop, MD1; Paola A. Suarez, MPH2; Lisa A. DiPonio, MD3; Doug Ota, MD, PhD1,4; Catherine M. Curtin, MD5,6 (supported by the VA RR&D Career Development Award);
1Department of Orthopaedic Surgery, Stanford University, Palo Alto, California, USA;
2Center for Health Care Evaluation, Department of Veterans Affairs (VA),
Menlo Park, California, USA;
3Department of PM&R, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA;
4Spinal Cord Injury Service, VA Health Care System, Palo Alto, California, USA;
5Rehabilitation Research and Development, VA Health Care System, Palo Alto, California, USA;
6Division of Plastic Surgery, Stanford University, Palo Alto, California, USA

Purpose: The purpose of this study was to compare perioperative morbidity and mortality after operative and nonoperative treatment of femoral fractures in a large cohort of patients with and without spinal cord injury (SCI).

Methods: This was a retrospective cohort study in the Veterans Affairs (VA) hospital system comparing femur fracture patients with and without spinal cord injury over a 5-year period (2001-2006). Demographic information, fracture pattern, and morbidity and mortality data were extracted and analyzed.

Results: We identified 396 veterans with femur fractures and SCI during the study period as compared to 13,350 veterans with femur fractures but without SCI. The SCI group was younger (60 vs 74 years) and had more distal fractures compared to the non-SCI group (51% shaft or distal femur vs 7% shaft or distal femur). In the SCI group, 37% of patients had their fractures managed surgically compared to 78% in the non-SCI group. The only significant difference in morbidity between operatively and nonoperatively treated SCI patients was in the development of decubitus ulcers, with the nonoperative group being more frequently affected. There was no difference in mortality between SCI patients treated with and without surgery. In the non-SCI group, mortality was higher in patients managed nonoperatively as were rates of respiratory failure and thromboembolic events. Bleeding complications were more common in non-SCI patients managed surgically.

Conclusion: This study did not find increased rates of morbidity or mortality among SCI patients treated surgically for femur fractures. On the contrary, the only significant difference in adverse events between SCI groups was a higher rate of pressure ulcers in those who did not have surgery. Surgical treatment optimizes nursing care, physical therapy, and patient mobilization, minimizing the risks of prolonged bed-rest and immobilization. When modern surgical techniques are coupled with meticulous and individualized perioperative management, surgery can be safe and effective. Subsequent research should aim to identify patients and fracture patterns that would benefit the most from surgery.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.