Skeletal fracture demographics in spinal cord-injured patients

Introduction. The demographics of skeletal fractures found in patients presenting with a spinal cord injury to a modern level-one trauma center have not been reported. Materials and methods. A retrospective review was performed of 1290 patients presenting between January 1997 and December 1999 with an acute vertebral fracture and spinal cord or cauda equina injury to determine the incidence, fracture type, and mechanism of all fractures of the extremities and pelvis. Results. Overall, 128 (10% of 1290) of these patients sustained 203 associated skeletal fractures including 16 open fractures (8% of 203). The most common associated fractures involved the radius, tibia, femur, humerus, fibula, and ulna. Some 48% of the injuries was due to motor vehicle accidents, 41% to falls, 6% to recreational injuries or assaults, and 5% to gunshot wounds. Twenty-four patients (1.8% of 1290) were found to have more than one vertebral fracture and sustained a high rate of associated fractures (42 fractures), averaging 1.8 fractures per patient. Conclusion. This study underscores the frequent association between vertebral fractures and fractures of the appendicular skeleton and pelvis and reinforces the need to maintain a high index of suspicion when evaluating neurologically injured patients due to the potential for symptom masking of acute nonspinal fracture.