Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study
Study design This is a retrospective case–control study. Objectives To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI). Setting US Veterans Health Administration facilities (2005–2015). Methods Fracture-amputation...
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| Veröffentlicht in: | Spinal cord 2023-04, Vol.61 (4), p.260-268 |
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| creator | Elam, Rachel E. Ray, Cara E. Miskevics, Scott Weaver, Frances M. Gonzalez, Beverly Obremskey, William Carbone, Laura D. |
| description | Study design
This is a retrospective case–control study.
Objectives
To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI).
Setting
US Veterans Health Administration facilities (2005–2015).
Methods
Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race.
Results
Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7–382), PVD (OR = 30; 95% CI, 2.5–371), and primary nonsurgical management (OR = 40; 95% CI, 1.5–1,116) were independent predictors of LE fracture-related amputation.
Conclusions
Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making. |
| doi_str_mv | 10.1038/s41393-023-00879-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2795359673</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2794407897</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-579dda99a22a2a12c33e6fd6885290bef6e721fa98c61ac890539a078849fab03</originalsourceid><addsrcrecordid>eNp9kcuKFTEQhhtRnHH0BVxIwI2b1ly6c3EngzcY0IWuQ510tfahu9NWEmbORnwH39AnMc4ZFVy4CBWor_6i-JrmoeBPBVf2WeqEcqrlsj5ujWvFreZUdEa3vZbd7fpXWrZdZU6aeyntOedOOHu3OVHaONMZc9p8fU84TCFHSiyObI6XSAyvMuEy5QMbCUIuhC3hDBkHBstWMuQprmxa2YaU4prY5ZQ_s0xQltoKLG3TCjMLkYZK7QsdnjNgARL--PY9xDVTnFnKZTjcb-6MMCd8cFPPmo-vXn44f9NevHv99vzFRRuU6XPbGzcM4BxICRKEDEqhHgdtbS8d3-Go0UgxgrNBCwjW8V454Mbazo2w4-qseXLM3Sh-KZiyX6YUcJ5hxViSl8b1qnfaqIo-_gfdx0L1nmuq62qqM5WSRypQTIlw9BtNC9DBC-5_2fFHO77a8dd2vKhDj26iy27B4c_Ibx0VUEcg1db6Cenv7v_E_gTZXp3X</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2794407897</pqid></control><display><type>article</type><title>Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Elam, Rachel E. ; Ray, Cara E. ; Miskevics, Scott ; Weaver, Frances M. ; Gonzalez, Beverly ; Obremskey, William ; Carbone, Laura D.</creator><creatorcontrib>Elam, Rachel E. ; Ray, Cara E. ; Miskevics, Scott ; Weaver, Frances M. ; Gonzalez, Beverly ; Obremskey, William ; Carbone, Laura D.</creatorcontrib><description>Study design
This is a retrospective case–control study.
Objectives
To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI).
Setting
US Veterans Health Administration facilities (2005–2015).
Methods
Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race.
Results
Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7–382), PVD (OR = 30; 95% CI, 2.5–371), and primary nonsurgical management (OR = 40; 95% CI, 1.5–1,116) were independent predictors of LE fracture-related amputation.
Conclusions
Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/s41393-023-00879-1</identifier><identifier>PMID: 36797477</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/163/2743/316/801 ; 692/308/174 ; 692/499 ; Amputation ; Amputation, Surgical ; Anatomy ; Biomedical and Life Sciences ; Biomedicine ; Case studies ; Case-Control Studies ; Comorbidity ; Decision making ; Diabetes mellitus ; Disease management ; Electronic health records ; Electronic medical records ; Fractures ; Fractures, Bone - complications ; Fractures, Bone - epidemiology ; Fractures, Bone - surgery ; Human Physiology ; Humans ; Long bone ; Lower Extremity - blood supply ; Lower Extremity - surgery ; Neurochemistry ; Neuropsychology ; Neurosciences ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Spinal cord injuries ; Spinal Cord Injuries - complications ; Spinal Cord Injuries - epidemiology ; Spinal Cord Injuries - surgery ; Statistical analysis ; Vascular diseases</subject><ispartof>Spinal cord, 2023-04, Vol.61 (4), p.260-268</ispartof><rights>The Author(s), under exclusive licence to International Spinal Cord Society 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to International Spinal Cord Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-579dda99a22a2a12c33e6fd6885290bef6e721fa98c61ac890539a078849fab03</citedby><cites>FETCH-LOGICAL-c375t-579dda99a22a2a12c33e6fd6885290bef6e721fa98c61ac890539a078849fab03</cites><orcidid>0000-0001-9927-6063 ; 0000-0002-5495-4649</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41393-023-00879-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41393-023-00879-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36797477$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elam, Rachel E.</creatorcontrib><creatorcontrib>Ray, Cara E.</creatorcontrib><creatorcontrib>Miskevics, Scott</creatorcontrib><creatorcontrib>Weaver, Frances M.</creatorcontrib><creatorcontrib>Gonzalez, Beverly</creatorcontrib><creatorcontrib>Obremskey, William</creatorcontrib><creatorcontrib>Carbone, Laura D.</creatorcontrib><title>Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Study design
This is a retrospective case–control study.
Objectives
To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI).
Setting
US Veterans Health Administration facilities (2005–2015).
Methods
Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race.
Results
Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7–382), PVD (OR = 30; 95% CI, 2.5–371), and primary nonsurgical management (OR = 40; 95% CI, 1.5–1,116) were independent predictors of LE fracture-related amputation.
Conclusions
Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making.</description><subject>692/163/2743/316/801</subject><subject>692/308/174</subject><subject>692/499</subject><subject>Amputation</subject><subject>Amputation, Surgical</subject><subject>Anatomy</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Case studies</subject><subject>Case-Control Studies</subject><subject>Comorbidity</subject><subject>Decision making</subject><subject>Diabetes mellitus</subject><subject>Disease management</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Fractures</subject><subject>Fractures, Bone - complications</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - surgery</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Long bone</subject><subject>Lower Extremity - blood supply</subject><subject>Lower Extremity - surgery</subject><subject>Neurochemistry</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Spinal cord injuries</subject><subject>Spinal Cord Injuries - complications</subject><subject>Spinal Cord Injuries - epidemiology</subject><subject>Spinal Cord Injuries - surgery</subject><subject>Statistical analysis</subject><subject>Vascular diseases</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kcuKFTEQhhtRnHH0BVxIwI2b1ly6c3EngzcY0IWuQ510tfahu9NWEmbORnwH39AnMc4ZFVy4CBWor_6i-JrmoeBPBVf2WeqEcqrlsj5ujWvFreZUdEa3vZbd7fpXWrZdZU6aeyntOedOOHu3OVHaONMZc9p8fU84TCFHSiyObI6XSAyvMuEy5QMbCUIuhC3hDBkHBstWMuQprmxa2YaU4prY5ZQ_s0xQltoKLG3TCjMLkYZK7QsdnjNgARL--PY9xDVTnFnKZTjcb-6MMCd8cFPPmo-vXn44f9NevHv99vzFRRuU6XPbGzcM4BxICRKEDEqhHgdtbS8d3-Go0UgxgrNBCwjW8V454Mbazo2w4-qseXLM3Sh-KZiyX6YUcJ5hxViSl8b1qnfaqIo-_gfdx0L1nmuq62qqM5WSRypQTIlw9BtNC9DBC-5_2fFHO77a8dd2vKhDj26iy27B4c_Ibx0VUEcg1db6Cenv7v_E_gTZXp3X</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Elam, Rachel E.</creator><creator>Ray, Cara E.</creator><creator>Miskevics, Scott</creator><creator>Weaver, Frances M.</creator><creator>Gonzalez, Beverly</creator><creator>Obremskey, William</creator><creator>Carbone, Laura D.</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9927-6063</orcidid><orcidid>https://orcid.org/0000-0002-5495-4649</orcidid></search><sort><creationdate>20230401</creationdate><title>Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study</title><author>Elam, Rachel E. ; Ray, Cara E. ; Miskevics, Scott ; Weaver, Frances M. ; Gonzalez, Beverly ; Obremskey, William ; Carbone, Laura D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-579dda99a22a2a12c33e6fd6885290bef6e721fa98c61ac890539a078849fab03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>692/163/2743/316/801</topic><topic>692/308/174</topic><topic>692/499</topic><topic>Amputation</topic><topic>Amputation, Surgical</topic><topic>Anatomy</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Case studies</topic><topic>Case-Control Studies</topic><topic>Comorbidity</topic><topic>Decision making</topic><topic>Diabetes mellitus</topic><topic>Disease management</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Fractures</topic><topic>Fractures, Bone - complications</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - surgery</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Long bone</topic><topic>Lower Extremity - blood supply</topic><topic>Lower Extremity - surgery</topic><topic>Neurochemistry</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Spinal cord injuries</topic><topic>Spinal Cord Injuries - complications</topic><topic>Spinal Cord Injuries - epidemiology</topic><topic>Spinal Cord Injuries - surgery</topic><topic>Statistical analysis</topic><topic>Vascular diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elam, Rachel E.</creatorcontrib><creatorcontrib>Ray, Cara E.</creatorcontrib><creatorcontrib>Miskevics, Scott</creatorcontrib><creatorcontrib>Weaver, Frances M.</creatorcontrib><creatorcontrib>Gonzalez, Beverly</creatorcontrib><creatorcontrib>Obremskey, William</creatorcontrib><creatorcontrib>Carbone, Laura D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Applied & Life Sciences</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elam, Rachel E.</au><au>Ray, Cara E.</au><au>Miskevics, Scott</au><au>Weaver, Frances M.</au><au>Gonzalez, Beverly</au><au>Obremskey, William</au><au>Carbone, Laura D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>61</volume><issue>4</issue><spage>260</spage><epage>268</epage><pages>260-268</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><abstract>Study design
This is a retrospective case–control study.
Objectives
To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI).
Setting
US Veterans Health Administration facilities (2005–2015).
Methods
Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race.
Results
Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7–382), PVD (OR = 30; 95% CI, 2.5–371), and primary nonsurgical management (OR = 40; 95% CI, 1.5–1,116) were independent predictors of LE fracture-related amputation.
Conclusions
Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>36797477</pmid><doi>10.1038/s41393-023-00879-1</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9927-6063</orcidid><orcidid>https://orcid.org/0000-0002-5495-4649</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Spinal cord, 2023-04, Vol.61 (4), p.260-268 |
| issn | 1362-4393 1476-5624 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | 692/163/2743/316/801 692/308/174 692/499 Amputation Amputation, Surgical Anatomy Biomedical and Life Sciences Biomedicine Case studies Case-Control Studies Comorbidity Decision making Diabetes mellitus Disease management Electronic health records Electronic medical records Fractures Fractures, Bone - complications Fractures, Bone - epidemiology Fractures, Bone - surgery Human Physiology Humans Long bone Lower Extremity - blood supply Lower Extremity - surgery Neurochemistry Neuropsychology Neurosciences Prospective Studies Retrospective Studies Risk Factors Spinal cord injuries Spinal Cord Injuries - complications Spinal Cord Injuries - epidemiology Spinal Cord Injuries - surgery Statistical analysis Vascular diseases |
| title | Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case–control study |
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