title: Surgical compared with nonsurgical management of fractures in male veterans with chronic spinal cord injury.
abstract: METHODS
  Retrospective review of a clinical database.
  
  
  OBJECTIVE
  To examine treatment modalities of incident appendicular fractures in men with chronic SCI and mortality outcomes by treatment modality.
  
  
  METHODS
  United States Veterans Health Administration Healthcare System.
  
  
  METHODS
  This was an observational study of 1979 incident fractures that occurred over 6 years among 12 162 male veterans with traumatic SCI of at least 2 years duration from the Veterans Health Administration (VA) Spinal Cord Dysfunction Registry. Treatment modalities were classified as surgical or nonsurgical treatment. Mortality outcomes at 1 year following the incident fracture were determined by treatment modality.
  
  
  RESULTS
  A total of 1281 male veterans with 1979 incident fractures met inclusion criteria for the study. These fractures included 345 (17.4%) upper-extremity fractures and 1634 (82.6%) lower-extremity fractures. A minority of patients (9.4%) were treated with surgery. Amputations and disarticulations accounted for 19.7% of all surgeries (1.3% of all fractures), and the majority of these were done more than 6 weeks following the incident fracture. There were no significant differences in mortality among men with fractures treated surgically compared with those treated nonsurgically.
  
  
  CONCLUSIONS
  Currently, the majority of appendicular fractures in male patients with chronic SCI are managed nonsurgically within the VA health-care system. There is no difference in mortality by type of treatment.
authors.affiliation: 1] Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA [2] Department of Medicine, Georgia Regents University, Augusta, GA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bethel
authors.affiliation: 1] Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA [2] Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: L
authors.initials: L
authors.lastname: Bailey
authors.affiliation: 1] Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA [2] Stritch School of Medicine, Loyola University, Maywood, IL, USA.
authors.forename: F
authors.initials: F
authors.lastname: Weaver
authors.affiliation: 1] Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA [2] Department of Medicine, Georgia Regents University, Augusta, GA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Le
authors.affiliation: 1] VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA [2] Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Burns
authors.affiliation: 1] VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA [2] Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Svircev
authors.affiliation: 1] Robert J. Dole Veterans Affairs Medical Center, Wichita, KS, USA [2] Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Heggeness
authors.affiliation: 1] Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA [2] Department of Medicine, Georgia Regents University, Augusta, GA, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Carbone
mesh_terms: D000368:Aged; D002908:Chronic Disease; D019468:Disease Management; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology; D018709:Statistics, Nonparametric; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans