Introduction Powered robotic exoskeletons are a promising solution to enable standing and walking in patients with spinal cord injury (SCI). Although training and walking with an exoskeleton in motor complete SCI patients is considered safe, the risks of unexpected (technical) adverse events and the risk of fractures are not fully understood. This article reports the occurrence of two different cases of bone fracture during exoskeleton usage. Furthermore, advice is given for extra safety training and instructions. Case presentation The first case concerns a 47-year-old woman with T12 AIS A SCI. Her exoskeleton shut down unexpectedly probably causing a misalignment of the joints of her lower extremities relative to the joints of the exoskeleton, which resulted in a fracture of her left tibia. The second case involves a 39-year-old man with L1 AIS B SCI. An unexpected fracture of the right distal tibia occurred without a specific prior (traumatic) incident. Discussion Exoskeleton training instructors, SCI patients and their buddies should be instructed how to handle emergency situations. Furthermore, they should be aware of the risk of stress fractures of the lower extremities. Proper alignment of the exoskeleton relative to the body is of utmost importance to reduce fracture risk. In the case of swelling and discoloring of the skin, radiographic examination should be performed in order to exclude any fracture.

中文翻译：

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病例报告：描述使用动力外骨骼期间发生的两次骨折。

简介 动力机器人外骨骼是一种很有前途的解决方案，可以帮助脊髓损伤 (SCI) 患者站立和行走。尽管运动完全性 SCI 患者使用外骨骼进行训练和行走被认为是安全的，但意外（技术）不良事件的风险和骨折的风险尚未完全了解。本文报道了外骨骼使用过程中发生的两起不同的骨折病例。此外，还提供了额外安全培训和说明的建议。病例介绍 第一个病例涉及一名 47 岁女性，患有 T12 AIS A SCI。她的外骨骼意外关闭，可能导致她的下肢关节相对于外骨骼的关节错位，从而导致她的左胫骨骨折。第二个病例涉及一名 39 岁男子，患有 L1 AIS B SCI。右胫骨远端发生意外骨折，之前没有特定的（创伤性）事件。讨论 应指导外骨骼训练教练、SCI 患者及其好友如何处理紧急情况。此外，他们应该意识到下肢应力性骨折的风险。外骨骼相对于身体的正确对准对于降低骨折风险至关重要。如果皮肤肿胀和变色，应进行放射线检查以排除任何骨折。