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L - Skeletal Integrity

Fracture Management The majority of SCI individuals will sustain a lower extremity fracture, during their lifetime. Appropriate fracture management strategies are imperative to reduce morbidity. For those with distal lower extremity fractures requiring immobilization: • Bivalve cast with malleolar windows to monitor skin • Medication review to: - Optimize callous formation - Promote fracture healing - Treat established osteoporosis • DVT (deep vein thrombosis) prophylaxis • Wheelchair adaptations to prevent pressure ulcers - Elevating leg rest - Power mobility • Assess impact of immobilization device on transfers and self care - Provision of sliding board or lift - Increased attendant care supports • Monitor emotional wellbeing Fragility fractures after SCI frequently result in delayed union, nonunion or malunion. Ultrasound has been shown as an effective therapy to help speed healing. Elimination in variability of fracture management and post fracture care, employed across Canada, is an obvious intervention target. FIGURE 9.0 Soft splints that alow for optimal mobilization while seated are often preferable for patients who require non-operati ve fracture management. Canadian Content Experts Likely to Influence Practice in Next Five Years 1. Jonathan Adachi, MD (Rheumatology), Hamilton: Past President of Osteoporosis Canada, and member of the Scientific Advisory Council of the International Osteoporosis Foundation. Expertise in osteoporosis therapies, gluccocorticoid induced osteoporosis, non-invasive measurement of bone with dual energy x-ray absorptiometry, MRI and peripheral QCT, quality of life and health economics, as it relates to osteoporosis. 2. Anthony Burns, MD (Physiatry), Toronto: Runs a tertiary bone health clinicfor individuals with mobility impairments, and has expertise in the management of skeletal integrity across neurologic impairment groups. 3. Angela Cheung, MD (Internal Medicine), Toronto: Led a number of non-pharmacologic and pharmacologic clinical intervention trials, relevant to rehab service delivery. 4. Cathy Craven, MD (Physiatry), Toronto: involved in a longitudinal study of bone health and body composition, and has expertise in the conduct of trials evaluating drug therapy and rehabilitation interventions, for treatment of SLOP, contrasting the feasibility and diagnostic yield of knee region DXA versus PQCT. 5. Isabelle Côté, MD (Physiatry), Québec: Co-leads an interprovincial team examining the feasibility and test-retest reliability of knee region DXA, among SCI patients. 6. Lora Giangregorio, PhD (Kinesiology), Waterloo: Involved in a longitudinal study of bone health and body composition, and is leading refinement of pQCT measurement protocols. Member of the Scientific Advisory to Osteoporosis Canada, and has expertise in exercise interventions for individuals with vertebral fracture. 7. Susan Jaglal, PhD (Epidemiology), Toronto: Expertise in health services research, particularly in examining access to diagnostic services and appropriate therapy in high-risk and post-fracture populations; translation of service gaps into policy recommendations. Member of PHAC Osteoporosis Surveillance working group, and Principal Investigator for the evaluation of the Ontario Osteoporosis Strategy. 8. Nicole Mittmann, PhD (Pharmacology), Toronto: Expertise in the conduct of economic evaluations, co-leading a study to describe the direct medical costs of lower extremity fracture. 9. Alex Papaioannou, MD (Geriatrics), Hamilton: Past Chair, Scientific Advisory Council for Osteoporosis Canada, expertise in knowledge translation  research,and focused the osteoporosis community on fracture risk reduction, through development of the 2010 Osteoporosis Canada guidelines. 10. Shabbir Alibhai, MD (Internal Medicine), Toronto: Expertise in the management of osteoporosis, in men with prostate cancer or on androgen deprivation therapy. SKELETAL INTEGRITY | BODY STRUCTURE AND FNUCTION 123


L - Skeletal Integrity
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