Factors associated with contractures in acute spinal cord injury

The purpose of this study was to examine the occurrence of contractures in acute SCI and clarify possible contributing factors such as early versus late admission, level of injury, completeness of the lesion, pressure ulcers, spasticity, co-existent head injury, extremity fractures, heterotopic ossification (HO), peripheral nerve injury, and shoulder pain. The records of all patients (n = 482) admitted between 1990 and 1995 with acute SCI to a model SCI system were reviewed. Of 482 patients 44 (9%) (33 male, 11 female) developed contractures during their initial hospitalization. There were 30 tetraplegic and 14 paraplegic patients. Thirty-four patients had complete and 10 patients had incomplete lesions. The percentage of occurrence of contractures among patients admitted to the model system on the day of injury was 7.6% and among those admitted between 2 and 60 days of the injury was 15% (P = 0.05). Patients with a pressure ulcer (14.1%) were significantly more likely to have a contracture than patients without a pressure ulcer (7.1%) (P = 0.05). Contractures were also more common in patients with spasticity requiring medication; 12.7% of patients with spasticity compared to 7.8% without spasticity, had contractures (P < 0.05). Patients with a co-existent or suspected head injury (15%) were more likely to have contractures than patients without it (7.4%)(P < 0.05). Eighteen patients with a contracture had HO, extremity fracture, peripheral nerve injury or reflex sympathetic dystrophy. In conclusion, this study is one of the first to demonstrate a significant association of contractures in acute SCI with pressure ulcers and co-existent head injury and reaffirms the importance of early admission to a coordinated SCI center in the prevention of contractures.