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INTRODUCTION AND OBJECTIVES: Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS: A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS: After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06 ± 9.05; 95% confidence interval [CI], 7.40-14.71; p < 0.001). CONCLUSIONS: This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).
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INTRODUCTION AND OBJECTIVES: Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS: A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS: After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06±9.05; 95% confidence interval [CI], 7.40-14.71; p<0.001). CONCLUSIONS: This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).
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Athletic pubalgia presents with groin and/or pubic pain mainly in athletes. The purpose of this review is to analyze, by evaluating current literature, the clinical examination and differential diagnosis of athletic pubalgia, in an effort to better understand this clinical entity. Diagnosis is challenging due to the anatomical complexity of the groin area, the biomechanics of the pubic Romasymphysis region and the large number of potential sources of groin pain. Clinical examination and medical history are of utmost importance. Differential diagnosis includes intra-and-extra-articular hip and intra-abdominal pathology, as well as non-myoskeletal disorders, such as femoroacetabular impingement (FAI), acetabular labral tears, osteitis pubis, adductor muscles injuries and true inguinal hernia. A thorough clinical examination should be performed in such cases, including the "Resisted sit-up" and the "Single or Bilateral Resisted Leg Adduction" test. Regarding imaging, Magnetic resonance imaging (MRI) should be performed when athletic pubalgia is suspected, especially in athletes. Other imaging techniques, such as plain radiographs and ultrasonography may add to the diagnostic process.
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Dor Abdominal/diagnóstico , Atletas , Virilha , Exame Físico/métodos , Acetábulo/lesões , Diagnóstico Diferencial , Impacto Femoroacetabular/diagnóstico , Virilha/diagnóstico por imagem , Hérnia Inguinal/diagnóstico , Humanos , Imageamento por Ressonância Magnética/métodos , Anamnese , Músculo Esquelético/lesões , Osteíte/diagnóstico , Sínfise Pubiana , Radiografia , UltrassonografiaRESUMO
Knowing the initial hematocrit of a polytrauma patient can assist his trauma management. This paper describes a four-year study of 88 polytrauma patients. Fifty-nine were transfused, and eight were women (13.5%). The mean cost of the first hospitalization of patients who were transfused was 14,503 ; the mean cost of patients who were not transfused was 5,718 . HCT did not correlate with ICU stay; nor did days of hospitalization. The mean HCT of those who died was not much different from that of survivors (33.23 with standard deviation [SD] 7.43 versus 32.37 with SD 5.89). This study showed that initial HCT does not correlate with days of hospitalization or days in ICU, but that transfusion can predict higher total cost.
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Custos Hospitalares , Traumatismo Múltiplo , Transfusão de Sangue , Transfusão de Eritrócitos , Feminino , Hematócrito , Humanos , Traumatismo Múltiplo/terapia , Estudos RetrospectivosRESUMO
Trauma is a multifactor problem with economic, social, and political burdens. In this article, we estimate its economic extension. This 3-yr study includes 69 patients above 14 yr of age, who experienced multiple traumatic injuries. We review their economic impact on the National Health System of Greece. Mean patient age is 38.91 yr, and most are male (85.5%), nonsmoking (69.6%), and without open fractures (78.3%). As a result of their injuries, most patients (76.8%) stayed in the intensive care unit (ICU), underwent surgery (76.8%), were transfused (68.1%), and became infected (63.8%). Mean cost was 16,365.65, median cost 10,399.07, minimum value 554.17, and maximum value 89,243.52. Of the 69 patients, 12 died. The number of polytrauma patients is relatively small compared to the total amount of patients in hospital care, but their impact on health services is very high. Patients admitted to the ICU are at great risk of infection, which can almost triple financial cost and increase hospital stay.
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BACKGROUND: In order to introduce new pharmacological agents with the intent to inhibit the adhesion formation, it is important to test such products on laboratory animals under a protocol that can evaluate the quantitative and qualitative aspects of healing of the tendons. Most experimental models focus on the tensile strength and histological analysis of the tendons, failing to sufficiently quantify the degree of the adhesion formation. METHODS: The experiment included six male New Zealand rabbits that underwent surgery of their right forepaws. The deep flexor tendon of the middle finger was transected and repaired and after six weeks the rabbits were killed. In order to assess the extent of adhesions, the functional stiffness of the tendons and the range of motion of the specimens' fingers was studied using a tensile testing machine. The setup used allowed the simultaneous recording of the specimens' motion and the pulling force values. RESULTS: The mean values of the left and right forepaws were expressed in the same chart showing a clear difference between the operated and non operated forepaws. CONCLUSIONS: Using a relatively simple set up in the laboratory we had the chance to focus on a more elaborate analysis of the data with the help of low cost and accessible software.
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Traumatismos dos Tendões/fisiopatologia , Tendões/fisiologia , Resistência à Tração/fisiologia , Aderências Teciduais/fisiopatologia , Animais , Fenômenos Biomecânicos/fisiologia , Modelos Animais , Coelhos , Amplitude de Movimento Articular/fisiologiaRESUMO
Nerve wrap protectors are bioabsorbable synthetic materials made of collagen or extracellular matrix that provide a non-constricting encasement for injured peripheral nerves. They are designed to be used as an interface between the nerve and the surrounding tissue. After hydrated, they transform into a soft, pliable, nonfriable, easy to handle porous conduit. The wall of the nerve wrap has a longitudinal slit that allows to be placed around the injured nerve. Τhis article presents the surgical technique for median nerve neurolysis and nerve coverage using a collagen or an extracellular matrix nerve wrap protector in 10 patients with recurrent or persistent carpal -tunnel syndrome. All patients had a mean of three previous open carpal tunnel operations, which were not successful. The mean follow-up was 3 years. -Under axillary nerve block anaesthesia with the use of -pneumatic tourniquet, a standard open carpal tunnel approach was done incorporating the previous incision. Scar tissue was excised in a healthy bed and the median nerve was thoroughly released with external neurolysis. An appropriate length of nerve wrap protector was cut longitudinally according to the length of nerve release. The nerve wrap was loosely sutured with separate polypropylene sutures No. 7-0. A volar splint was applied for a mean of 2 weeks followed by progressive passive and active range of motion rehabilitation exercises of the wrist and fingers. At the last follow-up, all patients showed improvement of clinical symptoms, static two-point discrimination test and median nerve conduction studies, and absence of Tinel sign. Differences in outcome and complications with respect to the nerve wrap materials used were not observed.
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Implantes Absorvíveis , Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Adulto , Idoso , Colágeno , Matriz Extracelular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Recidiva , Reoperação , Resultado do TratamentoRESUMO
Menopause constitutes a significant cause of bone loss, and it is currently debated whether bone mass is preserved or begins to decline substantially before that time in women. We used pQCT of the tibia to estimate differences of bone mineral mass, bone geometry and derived strength between premenopausal and postmenopausal Caucasian women of different age-groups per decade of age (20-79y). For each individual, we assessed total, trabecular and cortical bone mineral content (BMC, mg) and volumetric bone mineral density (BMD, mg/cm3); total and cortical cross-sectional areas (CSA, mm2); periosteal circumference (PERI_C, mm); endosteal circumference (ENDO_C, mm); mean cortical thickness (CRT_THK, mm); and Stress-Strain Index (SSI) . Comparisons were made both between premenopausal (N=84) and postmenopausal (N=231) women as distinct groups, and among women of the different age-groups. Our results indicated that premenopausal women had significantly higher trabecular and cortical BMC and vBMD, with higher cortical CSA, CRT_THK and SSI than postmenopausal women. Moreover, significant differences of trabecular but not cortical BMC, vBMD or SSI were found between women of the younger (<48y) age-groups. PERI_C, ENDO_C displayed lower values in the 20-29y group and higher values in the 70-79y group, denoting significant differences of bone geometry with aging.
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Envelhecimento/fisiologia , Densidade Óssea/fisiologia , Pós-Menopausa/fisiologia , Pré-Menopausa/fisiologia , Tíbia/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
PURPOSE: To evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up. MATERIALS AND METHODS: Percutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25-50 medical grade stainless steel micro-needles (22 G, 2-6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment. RESULTS: Clinical evaluation included immediate and delayed follow-up studies of patient's general condition, NVS pain score, and neurological status. Imaging assessed implant's long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2-36 months). Comparing patients' scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed. CONCLUSION: Percutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.
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Cementoplastia/métodos , Fraturas Espontâneas/prevenção & controle , Neoplasias/complicações , Manejo da Dor/métodos , Dor/etiologia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Fluoroscopia , Seguimentos , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/patologiaRESUMO
Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. We present a case of a 47-year-old male with fever, fatigue, and a slow-growing thigh mass. The inflammatory markers were elevated and the MR images showed a well-defined intermuscular lesion with mild heterogeneous enhancement. The lesion was excised and histologic examination was consistent with an inflammatory myofibroblastic tumor. No adjuvant therapy was needed and the patient remained asymptomatic with no evidence of tumor recurrence during the 2 years of follow-up.
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Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women), 17-54 years old (mean: 31), were included in the present study. Group A (4SHS = 20) underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20) underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.
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Neurogenic heterotopic ossification (HO) is the ectopic formation of lamellar bone in non-osseous tissues following traumatic brain or spinal cord injury. The associated complications affect greatly their quality of life. This fact has shifted the focus of scientific effort towards the investigation and understanding of related risk factors and the pathophysiological mechanisms. Recent advancements include the investigation for genetic predisposition and association various biomarkers. In the present article we will analyze the current concepts on this topic, based on clinical and physiological evidence and we will discuss the potential areas for future research on this field.
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Lesões Encefálicas/complicações , Ossificação Heterotópica/etiologia , Traumatismos da Medula Espinal/complicações , Animais , Osso e Ossos/fisiopatologia , Lesões Encefálicas/fisiopatologia , Humanos , Ossificação Heterotópica/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologiaRESUMO
This study is a randomized prospective study comparing two fracture fixation implants, the extramedullary sliding hip screw (SHS) and the dual lag screw cephalomedullary nail, in the treatment of intertrochanteric femoral fractures in the elderly. One hundred and sixty-five patients with low-energy intertrochanteric fractures, classified as AO/OTA 31A, were prospectively included during a 2-year period (2005-2006). Patients were randomized into two groups: group A included 79 hip fractures managed with sliding hip screws and group B included 86 fractures treated with cephalomedullary nails. Delay to surgery, duration of surgery, time of fluoroscopy, total hospital stay, implant-related complications, transfusion requirements, re-operation details, functional recovery, and mortality were recorded. The mean follow-up was 36 months (24-56 months). The mean surgical time was statistically significantly shorter and fluoroscopy time longer for the group B. No intraoperative femoral shaft fractures occurred. There was no statistically significant difference in the functional recovery score, reoperation, and mortality rates between the 2 groups. A new type of complication, the so-called Z-effect phenomenon, was noticed in the cephalomedullary nail group. There are no statistically significant differences between the two techniques in terms of type and rate of complications, functional outcome, reoperation and mortality rates when comparing the SHS and the cephalomedullary nail for low-energy AO/OTA 31A intertrochanteric fractures. Our data do not support recommendations for the use of one implant over the other.
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Advances in diagnostic imaging, interventional radiology, chemotherapy and surgery greatly improved the outcome of patients with osteosarcoma, and made limb salvage possible without compromising survival. In these patients, the prognosis is influenced by the site and resectability of the tumor, prior malignancy, and histological response to preoperative chemotherapy. Unfortunately, the progress has not been as significant in the treatment of advanced osteosarcoma, namely metastatic, recurrent and unresectable tumor. Yet, although advanced and forecasting a dismal prognosis, advanced osteosarcoma is not necessarily untreatable. Aggressive local and medical treatments, including surgical removal of primary and/or metastatic disease are currently available; however, yet, most treatments aim at palliation. Palliative local treatments including isolated limb perfusion, radiation therapy, embolization, chemoembolization, thermal ablation and cryoablation, all have an important role for these patients. The aim of palliative treatments is to achieve a mild response by offering the least discomfort to the patient with the minimum possible complications, and possibly increase of survival.
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Neoplasias Ósseas/terapia , Osteossarcoma/terapia , Cuidados Paliativos , Ablação por Cateter , Quimioterapia do Câncer por Perfusão Regional , Embolização Terapêutica , HumanosRESUMO
Any surgical resection in the lower extremities in children will cause a leg length discrepancy from physeal resection. To avoid the resulting functional deficit, leg length discrepancy must be reconciled with surgical techniques to approximate equal leg lengths at skeletal maturity. Currently there are several manufacturers who offer options for prosthetic reconstruction with expandable implants. These implants can be expanded to a length projected on the basis of three factors: the length of bone resected, the anticipated future growth of the contralateral extremity, and the estimated discrepancy of limb length at skeletal maturity. In this article, we review the basic principles and guidelines for prediction of remaining bone growth and planning lengthening in children, and present the currently available expandable prostheses and the evolution performed over time.
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Alongamento Ósseo/métodos , Neoplasias Ósseas/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Desenvolvimento Ósseo , Criança , Humanos , Guias de Prática Clínica como Assunto , Próteses e ImplantesRESUMO
PURPOSE: We evaluated in vivo changes in lumbar lordosis and intervertebral discs in runners and assessed the relationship between these changes and degenerative disc disease in runners with and without a history of low back pain. MATERIALS AND METHODS: Using open upright magnetic resonance (MR) imaging, we prospectively studied changes in lumbar lordosis and intervertebral discs of 25 elite long-distance runners in two sitting postures (neutral and extended) before and after 1 h of running and compared the results with disc height and dehydration/degeneration. Seventeen of the 25 runners had a history of low back pain. RESULTS: After 1 h of running, mean lordosis in neutral posture reduced by 4°; reduction was significant in runners with a history of low back pain. A significant reduction in mean lordosis in extension was not observed. Mean disc height significantly reduced in both postures, without, however, any statistical significance between runners with and without a history low back pain in any posture. Variable degrees of disc dehydration/degeneration were observed in 23 runners (57 discs), more commonly at L5-S1. A significant difference of disc dehydration/degeneration between runners with and without a history of low back pain was not observed. CONCLUSIONS: Intervertebral discs undergo significant strain after 1 h of running that in the long term may lead to low back pain and degenerative disc disease. Runners, especially those with low back pain and degenerative disc disease, should be evaluated after training to preserve the normal lumbar lordosis.
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Degeneração do Disco Intervertebral/diagnóstico , Disco Intervertebral/patologia , Lordose/diagnóstico , Dor Lombar/diagnóstico , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética/métodos , Postura/fisiologia , Corrida , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
PURPOSE: To report the clinical and radiological outcome of limb salvage surgery with the STANMORE megaprostheses. METHODS: We retrospectively studied 33 patients with musculoskeletal tumor limb salvage surgery using STANMORE megaprostheses. Clinical evaluation was done using the Enneking and the Toronto Extremity Salvage Score (TESS). Radiographic evaluation was done using the International Society of Limb Salvage (ISOLS) score. RESULTS: At a mean follow-up of 18 months, 21 patients were alive with no evidence of disease and two patients were alive with metastatic disease; 9 patients died of metastatic disease and one patient of causes unrelated to the primary tumor. Local recurrence was not observed in any of the patients. The mean Enneking and TESS scores were 76 and 88.4%, respectively. The ISOLS score was excellent or good in 30 cases for bone remodelling, 30 cases for the interface, in 30 cases for anchorage, in 32 cases for the implant body, and in 33 cases for the articulation. Extracortical bone bridging greater than 25% was observed in 8 prostheses. Mechanical survival of the megaprostheses was 97% (32 megaprostheses). Complications included seroma and hematoma formation (12%), skin necrosis and dehiscence at the knee wound (9%), aseptic loosening and infection (6%), quadriceps tendon rupture and peroneal nerve palsy (3%). CONCLUSION: The local recurrence-free survival in this series supports limb salvage surgery. The 97% survival rate of the megaprostheses suggests that the STANMORE modular megaprostheses are valuable for reconstruction of bone defects after tumor resection.
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Membros Artificiais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Salvamento de Membro , Neoplasias Musculares/diagnóstico por imagem , Neoplasias Musculares/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The lumbar spines of 25 long-distance runners were examined using an upright magnetic resonance imaging scanner. All volunteer runners were scanned before and after running for 1 h. Scanning was performed with the runners seated upright (neutral), leaning forwards (flexion) and leaning backwards (extension). All measured discs showed a reduction in disc height after 1 h of running. A significant reduction in disc height was observed in all three body positions (neutral, flexion and extension) after 1 h of running. The results showed that, in flexion, extension and neutral positions, intervertebral discs undergo significant strain after 1 h of running. The lowest disc-height reduction was found at the L5 - S1 space in the neutral position; the same space had the highest percentage of disc degeneration.
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Atletas , Disco Intervertebral/fisiopatologia , Corrida/fisiologia , Adulto , Idoso , Estatura , Peso Corporal , Feminino , Humanos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/patologia , Dor Lombar/complicações , Dor Lombar/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto JovemRESUMO
Change in gait variability at least 6 months after surgical reconstruction of the anterior cruciate ligament (ACL) was assessed in 20 male patients with acute ACL deficiency and compared with pre-operative data and that from 20 healthy male controls. Gait was measured using a triaxial accelerometer and data were analysed by the Gait Evaluation Differential Entropy Method (GEDEM) to determine gait variability. Pain was assessed with a visual analogue scale and functional ability with the Oswestry Disability Index and the International Knee Documentation Committee score. Mean gait variability was significantly lower after than before surgery, with values for the anterior-posterior axis being in the normal range of controls after 6 months, whereas in the mediolateral axis mean gait variability remained significantly higher, indicating that some rotational instability remained in the time-frame of the study. Pain and functional ability scores improved after surgery compared with before surgery. The combination of accelerometry and GEDEM may be a useful orthopaedic tool for the post-operative evaluation of patients who have undergone ACL reconstruction.
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Ligamento Cruzado Anterior/patologia , Ligamento Cruzado Anterior/fisiopatologia , Marcha/fisiologia , Período Pós-Operatório , Período Pré-Operatório , Adulto , Antropometria , Estudos de Casos e Controles , Entropia , Humanos , MasculinoRESUMO
BACKGROUND AND AIM: Significant bone loss develops in the first months and continues years after spinal cord injury. A cross - sectional comparative study was performed to evaluate factors influencing bone loss in spinal cord injured men with paraplegia. PATIENTS AND METHODS: We studied 31 paraplegic men in chronic stage (>1.5 years) in comparison with 30 able-bodied men of similar age, height, and weight. The paraplegic men were allocated into 2 subgroups based on the neurological level of injury; high paraplegics (n=16, T4-T7 neurological level of injury) and low paraplegics (n=15, T8-T12 neurological level of injury). The influence of positive and negative factors (spasticity, standing-therapeutic walking, and duration of paralysis) on bone structures was evaluated by pQCT measurement of the total, trabecular and cortical bone mineral density (BMDtot, BMDtrab, BMDcort, respectively) and cortical thickness (THIcort) at the distal tibial epiphysis and the tibial diaphysis at 4% and 38% proximal to the distal end of the tibia. The stress strain index (SSI) was measured at 14% (SSI(2)) and at 38% (SSI(3)) of the tibial diaphysis, and the difference SSI(3) - SSI(2) (δSSI(3-2)) was calculated. RESULTS: In all paraplegics, bone mineral density parameters were significantly reduced compared to the control group (BMDtot: p<0.0005, BMDtrab: p<0.0005, BMDcort: p=0.029, THIcort: p=0.019, SSI(2): p=0.009, SSI(3): p=0.003, respectively). Paraplegics who used standing frames or long brace orthoses had statistically significant higher bone mass and geometric parameters (BMDtrab: p=0.03, BMDtot: p=0.01, THIcort: p=0.013, respectively), while spasticity did not protect bone. The duration of paralysis was significantly related to trabecular bone loss (r=-0.5, p=0.05) and cortical thickness (r=-0.6, p=0.006) in high paraplegics and to δSSI(3-2) in low paraplegics (r=0.534, p=0.03). CONCLUSIONS: The neurological level of injury adversely affects bone strength in paralyzed lower extremities such as the distal tibia. Standing or therapeutic walking could possibly have a positive effect in cortical and trabecular bone in paraplegia.