Development of a Classification System (OF-Classification) and a Score for Therapeutic Decision-Making (OF-Score) for Osteoporotic Thoracolumbar Fractures

Author:

Schnake Klaus John1,Hahn Patrick2,Franck Alexander3,Blattert Thomas4,Zimmermann Volker5,Ullrich Bernhard6,Gonschorek Oliver7,Müller Michael8,Katscher Sebastian9,Hartmann Frank10

Affiliation:

1. Center for Spinal Therapy, Schön Klinik Nürnberg Fürth, Fürth, Germany

2. St. Anna Hospital Herne, Herne, Germany

3. University of Leipzig, Leipzig, Germany

4. Orthopädische Fachklinik Schwarzach, Schwarzach, Germany

5. Klinikum Traunstein, Traunstein, Germany

6. BG-Unfallklinik Bergmannstrost, Halle, Germany

7. BG-Unfallklinik Murnau, Murnau, Germany

8. Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany

9. HELIOS Klinikum Borna, Borna, Germany

10. Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany

Abstract

Introduction The prevalence of osteoporotic fractures is continuously on the rise. The adequate treatment of the predominantly geriatric patients is quite challenging. Osteoporosis can either be the cause of thoracolumbar fractures (nontraumatic fracture) or act as a contributing factor in traumatic fractures. No commonly accepted classification for osteoporotic fractures currently exists. The goal of the “osteoporotic fracture” working group was to develop a classification system and a score to aid therapeutic decision-making process for patients with osteoporotic thoracolumbar fractures. Material and Methods The development of both the classification and the score followed an established methodological pathway. Extensive literature research followed by in-depth discussions in nine consecutive sessions of expert meetings resulted in the proposed classification and scoring system. Between the sessions the classification and the score were applied by the group members in daily practice. The radiological and clinical data of 707 consecutive patients were subsequently collected in 16 clinics and evaluated. Interobserver reliability was calculated after evaluation of 146 fractures by 6 raters. Results The OF-classification consists of five subgroups: OF 1—no deformation (edema in MRI STIR-sequence); OF 2—deformation without or with only minor involvement of the posterior wall (< 1/5); OF 3—deformation with distinct involvement of the posterior wall (> 1/5); OF 4—loss of vertebral frame structure, vertebral body collapse, or pincer type fracture; OF 5—injuries with distraction or rotation. Interobserver reliability showed substantial agreement (Kappa 0.63). The OF-score contains the following parameters: fracture morphology (OF-classification), bone mineral density, potential sintering of the fracture, pain, neurological deficit, potential mobilization, and general health status of the patient (ASA grading), respectively. According to the OF-score, 29% of patients should have received conservative treatment and 49% surgical treatment, respectively. The final choice of treatment in the participating clinics correlated in 85% of cases with the OF-score. Conclusion The OF-classification consists of five subgroups and shows substantial interobserver reliability. In comparison to other classifications, the OF-classification is easy to use and provides a superior differentiation of the typical osteoporotic fracture morphologies. The OF-score takes the clinical status of the predominantly geriatric patients into account to aid the decision-making process in adequate therapeutic strategies. The generated treatment recommendations reflect the actual treatment strategies of specialized clinical centers.

Publisher

SAGE Publications

Subject

Clinical Neurology,Orthopedics and Sports Medicine,Surgery

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3