@article{d0269875d2df419baf96d46eeb56763c,
title = "Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury",
abstract = "We used Veterans Health Administration (VHA) national administrative data files to identify a cohort (fiscal years 2005–2014) of veterans with spinal cord injuries and disorders (SCID) to determine risk factors for and consequences of lower extremity fracture nonunions. Odds ratios (OR) for fracture nonunion were computed using multivariable-adjusted logistic regression models. We identified three risk factors for nonunion: (i) older age (OR = 2.29; 95% confidence interval [CI] 1.21–4.33), (ii) longer duration of SCID (OR = 1.02; 95% CI 1.00–1.04), and (iii) fracture site (distal femur), with OR (comparison distal femur) including distal tibia/fibula (OR = 0.14; 95% CI 0.09–0.24), proximal tibia/fibula (OR = 0.19; 95% CI 0.09–0.38), proximal femur (OR = 0.10; 95% CI 0.04–0.21), and hip (OR = 0.13; 95% CI 0.07–0.26). Nonunions resulted in multiple complications, with upwards of 1/3 developing a pressure injury, 13% osteomyelitis, and almost 25% requiring a subsequent amputation. Our data have identified a high-risk population for fracture nonunion of older veterans with a long duration of SCID who sustain a distal femur fracture. In view of the serious complications of these nonunions, targeted interventions in these high-risk individuals who have any signs of delayed union should be considered.",
keywords = "FEMUR FRACTURES, FRACTURE NONUNION, FRACTURE-RELATED COMPLICATIONS, SPINAL CORD INJURY AND DISORDERS",
author = "Bridget Sinnott and Cara Ray and Frances Weaver and Beverly Gonzalez and Elizabeth Chu and Sarah Premji and Mattie Raiford and Rachel Elam and Scott Miskevics and Stephen Parada and Laura Carbone",
note = "Funding Information: This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Health Services Research and Development, VA IIR 15‐294: Best Practices for Management of Fractures in Spinal Cord Injuries and Disorders. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. Funding Information: This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Health Services Research and Development, VA IIR 15-294: Best Practices for Management of Fractures in Spinal Cord Injuries and Disorders. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. Authors? roles: BS: data curation, investigation, writing?original draft. CR: data curation, methodology, writing - original draft, writing - review and editing. FW: conceptualization, supervision, data curation, funding acquisition, formal analysis, methodology, writing - review and editing. BG?data curation, formal analysis, methodology, writing?review and editing. EC: data curation, writing?review and editing. SP: data curation, writing?review and editing. MR: data curation, writing?review and editing. RE: data curation, writing?original draft. SM: data curation, methodology, writing?review and editing. SP: conceptualization, investigation, methodology, writing?review and editing. LC: conceptualization, data curation, formal analysis, funding acquisition, methodology, writing?original draft. Publisher Copyright: {\textcopyright} 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by US Government employees and their work is in the public domain in the USA.",
year = "2022",
month = mar,
doi = "10.1002/jbm4.10595",
language = "English (US)",
volume = "6",
journal = "JBMR Plus",
issn = "2473-4039",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "3",
}