PURPOSE: To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs). METHODS: Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance. CONCLUSIONS These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.
Humans ; Spinal Fractures/etiology* ; Pressure Ulcer/complications* ; Iran/epidemiology* ; Spinal Cord Injuries/epidemiology* ; Risk Factors ; Spine ; Registries ; Urinary Incontinence/complications* ; Suppuration/complications*

PURPOSE: To assess the association between frailty and osteoporotic vertebral compression fracture (OVCF) and to evaluate the relationship between numbers of OVCFs and frailty. MATERIALS AND METHODS: We enrolled 760 subjects, including 59 patients (with OVCF) and 701 controls (without OVCF). Successful matching provided 56 patient-control pairs. We analyzed principal clinical and demographic information, which included sex, age, height, weight, body mass index (BMI), variable frailty phenotypes, and Oswestry Disability Index (ODI) and EuroQol 5-dimension questionnaire (EQ-5D) scores. The association between frailty and OVCF was ascertained. In addition, the degrees of disability and quality of life attributable to frailty were determined. RESULTS: The prevalence of frailty was significantly higher in the OVCF group than in the control group (p < 0.001). Most of the frailty phenotypes, such as exhaustion, physical inactivity, slowness, and handgrip strength, were also significantly observed in the OVCF group. Within the OVCF group, the participants with frailty had significantly higher disability and lower quality of life than those in a robust state (p < 0.001 for ODI and EQ-5D). In addition, the multivariate logistic regression analysis demonstrated that the patients with low BMI [odds ratio (OR)=0.704; 95% confidence interval (CI), 0.543–0.913] and ≥3 fractures (OR=9.213; 95% CI, 1.529–55.501) within the OVCF group were associated with higher odds of frailty. CONCLUSION: The present study showed significant relationships between frailty and OVCF, severity of symptoms, and disability induced by OVCF. Furthermore, frailty could be a causal and/or resulting factor of OVCFs.
Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Fractures, Compression/*complications/*epidemiology ; Frailty/*complications/*epidemiology ; Humans ; Male ; Middle Aged ; Osteoporotic Fractures/*complications/etiology ; Prevalence ; Propensity Score ; Quality of Life ; Spinal Fractures/*complications/*epidemiology ; Treatment Outcome

OBJECTIVETo explore incidence rate, influencing factors, leakage routes,and preventative measures of bone cement leakages in vertebral internal reinforcement operation including percutaneous vertebroplasty and percutaneous kyphoplasty.

METHODSFrom January 2010 to January 2012,94 patients with osteoporotic vertebral compressive fracture,vertebral metastases and vertebral hemangioma were treated by vertebral internal reinforcement operation. Among them, there were 39 males and 55 females aged 55 to 86 with an average of 69.4 years old. The reasons, types, incidence and complications of bone cement leakage were analyzed.

RESULTSTotally 21 patients (26 vertebral) occurred bone cement leakage, the main routes included basivertebral veins, and bone cortex, which mainly located on adjacent intervertebrae and around vertebral body, and most of them were asymptomatic leakage. For the treatment of OVCFs, incidence of bone cement leakage in PKP was lower than that of PVP (P < 0.05), while incidince of PVP in treating vertebral metastases was worse than in treating OVCFs (P < 0.05).

CONCLUSIONBone cement leakage is a common complication in PVP and PKP. Careful analysis before operation, cautiously monitors and grasp operation indication in operation can decrease incidence of it.

Aged ; Aged, 80 and over ; Animals ; Bone Cements ; adverse effects ; China ; epidemiology ; Female ; Fractures, Compression ; surgery ; Humans ; Incidence ; Kyphoplasty ; adverse effects ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Postoperative Complications ; epidemiology ; etiology ; Spinal Fractures ; surgery ; Vertebroplasty ; adverse effects

PURPOSE: To identify the incidence of new vertebral compression fractures in women after kyphoplasty and to analyze influential factors in these patients. MATERIALS AMD METHODS: One hundred and eleven consecutive female patients with osteoporotic vertebral compression fractures (VCFs) underwent kyphoplasty at 137 levels. These patients were followed for 15.2 months postoperatively. For the survey of new vertebral compression fractures, medical records and x-rays were reviewed, and telephone interviews were conducted with all patients. RESULTS: During that time 20 (18%) patients developed new VCFs. The rate of occurrence of new VCFs in one year was 15.5% using a Kaplan-Meier curve. Body mass index (BMI), symptom duration and kyphoplasty level were the statistically significant factors between the patient groups both with and without new VCFs after kyphoplasty. In the comparison between the adjacent and remote new VCF groups, the adjacent new VCF group showed a larger amount of polymethyl methacrylate (PMMA) use during kyphoplasty (p<0.05). Before kyphoplasty, 9.9% of the patients had been prescribed medication for osteoporosis, and 93.7% of the patients started or continued medication after kyphoplasty. The development of new VCFs was affected by the number of vertebrae involved in the kyphoplasty. However, the lower incidence rate (15.5%) of new compression fractures might be due to a greater percentage (93.7% in our study) of patients taking anti-osteoporotic medication before and/or after kyphoplasty. CONCLUSION: When kyphoplasty is planned for the management of patients with osteoporotic VCFs, the application of a small amount of PMMA can be considered in order to lower the risk of new fractures in adjacent vertebrae. The postoperative use of anti- osteoporotic medication is recommended for the prevention of new VCFs.
Aged ; Aged, 80 and over ; Bone Cements ; Female ; Follow-Up Studies ; Fractures, Compression/epidemiology/*surgery ; Humans ; Incidence ; Middle Aged ; Orthopedic Procedures ; Postoperative Complications ; Recurrence ; Risk Factors ; Spinal Fractures/epidemiology/*surgery ; Surgical Procedures, Minimally Invasive ; Treatment Outcome