Bone fracture during electrical stimulation of the quadriceps in a spinal cord injured subject

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Abstract

We report a fracture through the lateral femoral condyle of a paraplegic subject caused by electrical stimulation (ES). The subject was a 50-year-old man who 4 years earlier had sustained a complete spinal cord injury (SCI) at level T6. The fracture occurred during ES-induced measurement of maximal isometric torque of the quadriceps with the knee flexed at an angle of 90°. ES was delivered through surface electrodes with biphasic square wave pulses from a constant current stimulator. The torque was calculated to be 93Nm, corresponding to 20.8kg at the ankle. The regional bone mineral density of the entire lower extremities was .83g/cm2, corresponding to 60% of sex- and age-matched able-bodied reference values. Several factors are suspected to have contributed to the fracture: maximal ES in combination with a muscle spasm, servere osteoporosis, increased muscular strength induced by regular ES cycling (twice a week), and testing position with the knee locked in 90°flexion. The risk of fracture as well as various precautions are discussed and should be taken into consideration in future studies.

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Hartkopp, A., Murphy, R. J. L., Mohr, T., Kjœr, M., & Biering-Sørensen, F. (1998). Bone fracture during electrical stimulation of the quadriceps in a spinal cord injured subject. Archives of Physical Medicine and Rehabilitation, 79(9), 1133–1136. https://doi.org/10.1016/S0003-9993(98)90184-8

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