Reconsidering the Role of Frailty Index in Long Bone Fracture Management for Patients with Spinal Cord Injury

Saturday, November 2, 2024

12:15 PM – 12:30 PM

Location: Station 12: ROOM: POSTERLAND / Trinity Poster / Exhibit Hall REGION: Tower Lobby Level >>>

Presenting Author(s)

Talha Ahmad

Student
Medical College of Wisconsin
Milwaukee, Wisconsin, United States

Non-presenting Author(s)

LS

Lauren E. Shuda, MD

Assistant professor
Medical College of Wisconsin
Wauwatosa, Wisconsin, United States
CW

Christopher White, MD

Associate Professor
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
vm

vaishnavi muqeet, n/a

Assistant professor
Medical college of Wisconsin
brookfield, Wisconsin, United States

Research Objectives: To investigate the utility of frailty index in long bone fracture management for patients with spinal cord injury (SCI)

Design: Retrospective case series

Setting: The study was conducted at a specialized SCI center within a medical facility catering to veterans.

Participants: 258 patients with diplegia or tetraplegia at the SCI Center were identified through the Zablocki Veterans Affair Medical Center in Milwaukee, Wisconsin. Selection criteria was based on chart review, identifying 14 patients with long bone fractures who experienced medical complications due to non-surgical management.

Interventions: Not applicable

Main Outcome Measures: Before data collection began, the study aimed to test the hypothesis that the average frailty index among non-surgically managed SCI patients with long bone fractures would exceed the threshold for reconsidering surgery (37).

Results: The average frailty index among these patients was 39.25, surpassing the threshold of 37, indicating significant frailty.
Complications included amputations (4 patients), ulcers (12 patients), repeat fracture (1 patient), osteomyelitis (1 patient), and soft tissue abscess (1 patient).

Conclusions: Numerous studies have shown that surgical management of long bone fractures in SCI patients is associated with fewer complications compared to non-operative management. Despite this, compared to other patients, SCI patients with long bone fractures are non-operatively managed at a higher rate. A reason for this is the high baseline frailty index for SCI patients due to their need for assistance in activities of daily living and neurogenic bladders. There is a need to incorporate specific frailty indices or adjust surgical thresholds for this population, particularly for long bone fractures, to optimize outcomes and reduce complications. Future work for this research includes identifying SCI patients who underwent surgery for long bone fractures and compare their frailty index to those who underwent nonsurgical treatment. Further research that examines the outcome of surgical management of SCI patients with higher frailty index is warranted to refine these recommendations for routine clinical practice.

Author(s) Disclosures: No authors listed on the abstract have any disclosures to make.

Learning Objectives:

Upon completion, participant will be able to express the complications associated with non operative management of long bone fractures among spinal cord injured patients.
Upon completion, participant will be able to reflect on the need to adjust surgical thresholds such as frailty index for spinal cord injured patients.
Upon completion, participant will be able to describe why spinal cord injured patients with long bone fractures are non operatively managed at a higher rate.