Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury

Bridget Sinnott, Cara Ray, Frances Weaver, Beverly Gonzalez, Elizabeth Chu, Sarah Premji, Mattie Raiford, Rachel Elam, Scott Miskevics, Stephen Parada, Laura Carbone

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Article numbere10595
JournalJBMR Plus
Volume6
Issue number3
DOIs
StatePublished - Mar 2022

Keywords

  • FEMUR FRACTURES
  • FRACTURE NONUNION
  • FRACTURE-RELATED COMPLICATIONS
  • SPINAL CORD INJURY AND DISORDERS

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Fingerprint

Dive into the research topics of 'Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury'. Together they form a unique fingerprint.

Cite this