Analysis of Treatment Methods for Subsequent Vertebral Fractures Following Osteoporotic Compression Fractures

STUDY DESIGN: A multicenter retrospective study. OBJECTIVES: To compare the incidence and pattern of subsequent vertebral fractures following conservative treatment versus vertebroplasty or kyphoplasty for acute osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: Previous studies suggest that new vertebral fractures may increase following vertebroplasty or kyphoplasty because bony cement inserted into the vertebral body of a fractured bone can elevate its strength and stiffness, which in turn, may increase the probability of the compression fractures. MATERIALS AND METHODS: From three hospitals, we recruited 135 patients who had been treated for acute osteoporotic compression fractures and had available spine images taken at their 1-year follow-up. The patients were divided into two groups according to treatment methods. Group C had been managed conservatively, and Group VK had undergone vertebroplasty or kyphoplasty. The two groups were compared for subsequent vertebral fractures. RESULTS: Group C consisted of 76 patients, and Group VK had 59. There were no significant differences between the two groups in terms of age, sex, medical comorbidity, body mass index (BMI), bone mineral density, presence of prior vertebral fracture or acute fracture level (p>0.05). New vertebral fractures were detected in 25 patients (19% of total subjects): 6 (8%) from Group C, and 19 (32%) from Group VK, demonstrating a significantly higher incidence in the VK group (p=0.0007). In the subgroup analysis, there was no significant difference between vertebroplasty and kyphoplasty (p>0.05). While four of the six patients (67%) in Group C had subsequent fractures in nonadjacent vertebrae, 14 of the 19 patients (74%) in Group VK had subsequent fractures in adjacent vertebrae. CONCLUSIONS: Subsequent vertebral fractures were found in 19% of subjects at one year after treatment for acute osteoporotic compression fractures. Compared with conservative treatment, vertbroplasty or kyphoplasty significantly increased the occurrence of subsequent vertebral fractures, which appeared more often in adjacent vertebrae.

Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices / 대한고관절학회지

PURPOSE: To evaluate the factors affecting the bone union time and the occurrence of nonunion after intramedullary nailing of subtrochanteric femoral fractures in adults. MATERIALS AND METHODS: We retrospectively reviewed data from 31 patients (22 men and 9 women) who had undergone femoral intramedullary nailing at least 1 year post-operatively and analyzed the bone union time, nonunion rates, and factors that affected the bone union time according to the fracture classification (AO and Fielding classifications), comminution of the medial cortex, reduction method, and additional cerclage wiring. RESULTS: The average union time was 26.4 weeks. There were no differences in the bone union time according to the fracture classification, reduction method, or additional cerclage wiring. Significant differences were found in the bone union time between the medial cortex comminution and non-comminution groups. A relatively strong positive correlation was detected between the degree of post-operative displacement and the bone union time. Nonunion occurred in three cases and there was no failure of implants. CONCLUSION: The bone union time was not affected by the reduction method nor additional cerclage wiring in intramedullary nailing of subtrochanteric femur fractures. Comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to the delayed time of union.