Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre. / ¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia.

OBJECTIVE: To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. MATERIAL AND METHOD: A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. RESULTS: Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. DISCUSSION: There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. CONCLUSIONS: Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.

[Reduction of exercise-mediated endothelial dysfunction markers in sedentary adults with chronic spinal cord injury]. / Reducción de marcadores de disfunción endotelial mediante ejercicio en adultos sedentarios con lesión medular crónica.

BACKGROUND AND OBJECTIVE: Recent studies have found increased markers of endothelial activation in men with chronic spinal cord injury. This study was conducted to determine the effects of arm-cranking exercise on endothelial dysfunction in male adults with chronic SCI. METHOD: A prospective randomized study of 17 sedentary adult males with chronic SCI at or under T5 level. Nine performed a supervised exercise program at a moderate intensity (arm-cranking: 12 weeks, 3 sessions/week). Plasma levels of endothelin-1, soluble intercellular adhesion molecule type 1 (sICAM-1), and soluble vascular adhesion molecule type 1 (sVCAM-1) were assessed by ELISA. Outcome measurements also included physical fitness and total body fat mass percentage. RESULTS: We observed both in the randomized and in the before-after studies a significant reduction of the levels of endothelin-1 and sICAM-1. Furthermore, significant improvements of both physical fitness and body composition were also found. CONCLUSION: Arm-cranking exercise improved endothelial dysfunction in adult males with chronic SCI. Long-term studies are still required to determine whether the correction of endothelial dysfunction improves the clinical outcomes of adults with chronic SCI.

Ecuación predictora de masa grasa corporal en deportistas con lesión medular crónica: estudio piloto / Predictive equation of body fat percentage in athletes with chronic spinal cord injury: a pilot study

La determinación del porcentaje de masa grasa en pacientes con lesión medular crónica (LMC) resulta de interés por la alta morbimortalidad cardiovascular que presenta este grupo. En el caso de deportistas, además, permitiría optimizar su rendimiento deportivo. Por consiguiente, el presente estudio se planteó como primer objetivo comparar diferentes métodos de estudio del porcentaje de masa grasa de deportistas con LMC. Y como objetivo secundario, identificar alguna ecuación que permita predecir los niveles de masa grasa de manera más económica, sencilla, rápida y no invasiva. Se diseño un estudio observacional y transversal en el que participaron voluntariamente 8 deportistas varones con LMC a nivel o por debajo de T5 que compiten a nivel nacional. El porcentaje de masa grasa corporal de los participantes se determinó mediante tres metodologías: densitometría (DEXA), antropometría convencional (Ecuación de Siri) e impedancia bioeléctrica (BIA). Este protocolo fue aprobado por un Comité de Ética Institucional. El porcentaje de masa grasa presentado por jugadores de baloncesto en silla de ruedas tras someterse al método de referencia (DEXA) fue del 28,76±9,16%. El análisis de concordancia de Bland-Altman entre métodos sugiere que tanto la antropometría convencional como la BIA subestiman el porcentaje de masa grasa de deportistas con LMC. la ecuación de predicción obtenida fue: Masa Grasa (%)= 1,9197 (pliegue tríceps (mm)) + 6,5063. Tanto las técnicas antropométricas convencionales como la propia BIA subestiman la masa grasa en deportistas con LMC. Asimismo se ha identificado una ecuación de regresión para la predicción del porcentaje de masa grasa de bajo coste y aplicable en cualquier entorno.

The assessment of fat mass (FM) is of great interest for people with chronic spinal cord injury (SCI) given that morbidity and mortality from cardiovascular disease are greater and occur earlier in this group. Furthermore, it may play a key role improving physical performance in athletes with SCI. For the reasons already mentioned, the current study was designed to compare different methods for assessing FM in athletes with SCI. A secondary objective was to identify a predictive equation for FM in this group that is easily reproducible elsewhere. A total of 8 male athletes with complete SCI at or below the 5th thoracic level (T5) competing in a national league volunteered for this study. The percentage of FM was assessed by three different methods: conventional anthropometry (Siri equation), bioelectrical impedance analysis (BIA) and densitometry (DEXA). This research was conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki (version, 2002). Furthermore, the present protocol was approved by an Institutional Ethics Committee. Mean percentage of FM assessed by DXA was 28.76±9.16%. Moreover, Bland-Altman plots suggested conventional anthropometry and BIA underestimated fat mass percentage in this group. Lastly, a predictive equation for fat mass was established as follows: FM (%)=1.9197 (triceps skinfold thickness (mm))+6.5063. It was concluded that both conventional anthropometry and BIA underestimated fat mass in athletes with chronic SCI. Furthermore, a predictive equation of fat mass was recommended for this group due to its low cost and wide availability in any clinical setting.