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CHAPTER 18
brittle and often slight movements of the body during turning of the patient or passive
movements of a leg by a physiotherapist may produce a fracture of the femur, usually
called a 'spontaneous' fracture. The impacted supracondylar fracture is the typical
fracture sustained by paraplegics, from falling out of the wheelchair on to the knee
(Figs. loia and b). Fractures of the femur may occur as sport injuries in paraplegics.
This was seen in two untrained paraplegics who were engaged in basketball games.
In 1953 the author described 7 cases and he later collected with his colleagues Michaelis
and Melzak 100 cases of fracture due to osteoporosis in paraplegics. Comarr
et al.
(1962)
also reported these pathological fractures.
TREATMENT OF OSTEOPOROSIS
The aim of the treatment is to discontinue the immobilization of the patient as soon as
possible by frequent and regular changes of his position. In recent years, this has been
greatly facilitated through the introduction of the electrically controlled Stoke Mande-
ville-Egerton turning bed. Furthermore, frequent passive movements of the paralysed
limbs and active resistance exercises of the non-paralysed upper limbs with chest-
expanders have proved invaluable to improve the blood circulation. Of great importance
is the restitution of the disturbed nitrogen balance, especially in patients suffering from
pressure sores and osteomyelitis. This can be best achieved through repeated blood
transfusions whereby the oxygen carrying erythrocytes are essential for the tissue
metabolism. High protein diet combined with vitamins is essential, especially vitamin D
27-11-62
8-1-63
30-5-63
8-11-62
FIG. io2a.
