Quadriplegia caused by push-up exercises

Bilateral Radial Head Fracture Secondary to Weighted Push-Up Exercise: Case Report and Review of Literature of a Rare Injury

A 33-year-old male presented with bilateral radial head fractures after weighted prone push-up exercise. The patient had Mason type I and II on right and left sides, respectively. He was managed conservatively with limited immobilisation and early range of motion exercises. The fracture healed and patient had no complaints at the last follow-up of 13 months. Bilateral radial head fracture is rare with push-up exercise, and can be successfully treated conservatively with immobilisation and early rehabilitation. Although push-up exercises are an excellent workout with known benefits, unusual modifications of standard techniques should be avoided.

BIOMECHANICAL ANALYSIS OF THE ELBOW JOINT LOADING DURING PUSH-UP

The purpose of this study was to investigate the static and dynamic forces within the joints during push-up loading of the upper extremity.

Ten healthy male students volunteered for this study. They were asked to complete six sets of push-ups in five different hand positions. The Expert Vision Motion Analysis System with six CCD cameras, and a Kistler force plate was used to measure the relative joint position and ground reaction force.

Hand position was found to have a statistically significant effect on the axial force. The maximum axial force decreased from "normal" when hands were placed "apart" (45.0% BW, p = 0.012) or "superior" (44.5% BW, p = 0.01). Hand position had a significant effect on the flexion moment of the elbow joint. A greater reduction of flexion torque at 997.3 N-cm (p = 0.001) was experienced with hands "apart." Greater flexion torque existed throughout the cycle with hands "together" and equaled 2301.4 N-cm (p = 0.002).

This study provides information about the kinematic and kinetic patterns of the upper extremities, and how hand position affects intersegmental loading. Attention must be given to the valgus torque encountered during push-up exercises. Patients with medial collateral ligament repair and total elbow arthroplasty should be protected from such exercises immediately post-treatment.

Spinal cord infarction following cricotracheal resection

We report a case of an 18-year-old female who was referred to our institution after incurring a permanent quadriplegia resulting from spinal cord infarction following cricotracheal resection. Methods were case report and review of the literature. A tracheal stenosis had resulted from long-term intubation after premature birth, followed by tracheotomy after 1 year, surgical revision at 4 years of age and a spontaneous closure at the age of 6 after decannulation. At the age of 18, a cricotracheal resection was performed at another institution. At the termination of the procedure, a chin-to-chest suture was placed to prevent unintentional hyperextension of the neck. She was extubated on the third postoperative day, however, serious dyspnea required repeated re-intubation for 2 days thereafter. She developed paraplegia on the sixth postoperative day, prompting an MRI to be performed, which identified spinal cord edema. Intravenous administration of steroids in high doses was ineffective and unfortunately the patient has remained severely impaired since then. Permanent quadriplegia is a complication of cricotracheal resection with chin-to-chest sutures and should be included in the informed consent process. Therefore, a daily postoperative neurological examination should be performed in these patients. Immediate MRI should be performed if any abnormal findings are seen to verify the diagnosis. Quadriplegia in this setting likely resulted from compromised blood supply with concomitant edema, however, the exact cause of injury remains unclear: despite having chin-to-chest sutures, the patient's head remained in neutral position and was not in hyperflexion. Such an injury is likely more susceptible to steroid therapy if diagnosed as early as possible.

The epidemiology of traumatic spinal cord injury in Alberta, Canada

OBJECTIVES

To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada.

METHODS

The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner.

RESULTS

From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents.

CONCLUSION

Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.