Spinal cord injury and long bone fractures

Some of the work we are doing is volunteering with a group of refugees who all have spinal cord injuries, meaning they're paralyzed from the site of their injury down. In this house, there are 14 guys, one as young as 19. I've only had a few patients with injuries like this, so I know a bit about UTIs and pneumonia in these patients, but I'm learning quickly. One lesson was when one day one of the guys was injured during regular morning exercise with the physiotherapist.

That's his femur. Its a sizeable spiral fracture for those scoring at home. With spinal cord injury, both the immobility and the lack of sympathetic innervation lead to reductions in bone density, usually around 25% in the shaft of long bones. So what would be to us regular exercises broke this patient's leg. Thankfully he didn't feel much pain due to his spinal cord injury.

Unfortunately, there was no ambulance bay (or ambulances) at the hospital, so to get him there we had to manually put him from his bed to the car, manually transfer him from the car to another wheelchair, then from the wheelchair to a stretcher once in the hospital. Three transfers, each time possibly risking further injury where his razor-sharp bone fragments might sever his femoral artery. By the time we got the x-rays, he started to become hypotensive with a pretty swollen leg. All the moving made him bleed. Thankfully he was resuscitated with 2L saline.