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Multicenter evaluation of therapeutic strategies of inpatients with osteoporotic vertebral fractures in Germany

Klaus John Schnake 1 2Nabila Bouzakri 3Patrick Hahn 4Alexander Franck 5Thomas R Blattert 6Volker Zimmermann 7Oliver Gonschorek 8Bernhard Ullrich 9 10Frank Kandziora 11Michael Müller 12Sebastian Katscher 13Frank Hartmann 14Sven Mörk 15Akhil Verheyden 16Christian Schinkel 17Stefan Piltz 5 18Annett Olbrich 19

Eur J Trauma Emerg Surg doi: 10.1007/s00068-021-01708-x. 

Abstract

Purpose: The aim of this study was to assess therapeutic strategies of inpatients with osteoporotic thoracolumbar fractures (OTF) in Germany.

Methods: Prospective multi-center study including 16 German-speaking trauma centers over a period of 7 months. All inpatients with OTF were included. Radiological and clinical data on admission and treatment modalities were assessed.

Results: Seven hundred and seven (99.3%) out of 712 included patients (73.3% female) could be evaluated. Mean age was 75 years (30-103). 51.3% could not remember any traumatic incident. Fracture distribution was from T2 to L5 with L1 (19%) most commonly affected. According to the Magerl classification type A1 (52.1%) and A3 (42.7%) were most common. B and C type injuries (2.6%) and neurological deficits (3.1%) were rare. Previous progression of vertebral deformation was evident in 34.4% of patients and related to t score below – 3 (Odds ratio 1.9661). Patients presented with anticoagulation medication (15.4%), dementia (13%), and ASA score > 3 (12.4%) frequently. 82.3% of patients complained of pain > 4 on VAS, 37% could not be mobilized despite pain medication according to grade II WHO pain ladder. 81.6% received operative treatment. Kyphoplasty (63.8%) and hybrid stabilization including kyphoplasty with (14.4%) or without screw augmentation (7.6%) were the techniques most frequently used. Invasiveness of treatment increased with degree of instability.

Conclusions: OTF are mostly type A compression fractures. Patients suffer from severe pain and immobilization frequently. Progression of deformity is correlated to t score below – 3. Treatment of inpatients is mainly surgical, with kyphoplasty followed by hybrid stabilization as commonly used techniques.