Abstract

Background: Stroke and bone fracture may manifest as risk factors and complications for each other. Stroke and bone fracture may occur concurrently in patients presented to the emergency department.

Methods: Between January 2007 and December 2018, we retrospectively found 30 patients with coexistent acute ischemic stroke and bone fracture during hospitalization.

Results: Concurrent stroke and fracture (initial stroke), stroke followed by fracture (initial stroke), and fracture followed by stroke (initial fracture) occurred in 17, 4, and 9 patients, respectively. Femur was the most common fracture location. Stroke or fracture was initially overlooked in 4 of 17 patients (24%) with concurrent stroke and bone fracture. Both age and the admission National Institutes of Health Stroke Scale (NIHSS) score exhibited a positive linear correlation with the discharge modified Rankin Scale (mRS). Univariate logistic regressions found that significant factors influencing unfavorable outcome (mRS > 3) were an admission NIHSS score > 5, age > 70 years, urinary catheterization, nasogastric insertion, anterior circulation, and initial fracture. Stepwise regression analyses showed that an admission NIHSS score > 5 (odds ratio [OR]: 48.36, 95% confidence interval [CI]: 1.19–1963.26, p = 0.040), age > 70 years (OR: 30.03, 95% CI: 1.57–574.48; p = 0.024), and anterior circulation (OR: 27.41, 95% CI: 1.31–572.65; p = 0.033) were significant predictors of unfavorable outcomes with a prediction value of up to 0.938.

Conclusion: Coexistence of acute stroke and bone fracture is an uncommon but serious condition. Neurologists, orthopedics and emergency physicians need to be more vigilant toward this concomitance with careful clinical evaluation.