Abstract
Introduction
Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE.
Case
We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up.
Conclusion
PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.
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Acknowledgements
The authors would like to acknowledge the contributions of Dr. Cara McDonagh and her team in the National Rehabilitation Hospital, and Dr. Kieran Kelliher of Turloughmore Medical Centre for their ongoing care of the patient in this case. We would also like to acknowledge the staff at the Dublin City University Exoskeleton Programme for their assistance and expertise in the subject matter.
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This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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JM was the main author, and was responsible for data collection and liaison with the patient, review of the literature, and writing the manuscript. LN contributed to review of the literature, data collection, and contributed to writing the manuscript. DOS and MC were involved in initial literature search, and contributed to review and feedback on the manuscript. AD and CGM are senior authors who provided feedback and final approval of the manuscript.
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Mahon, J., Nolan, L., O’Sullivan, D. et al. Bilateral tibial fractures associated with powered exoskeleton use in complete spinal cord injury – a case report & literature review. Spinal Cord Ser Cases 10, 22 (2024). https://doi.org/10.1038/s41394-024-00635-4
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DOI: https://doi.org/10.1038/s41394-024-00635-4