Fractures in myelomeningocele.
BACKGROUND
In patients with myelomeningocele (MMC), a high number of fractures occur in the paralyzed extremities, affecting mobility and independence. The aims of this retrospective cross-sectional study are to determine the frequency of fractures in our patient cohort and to identify trends and risk factors relevant for such fractures.


METHODS
Between March 1988 and June 2005, 862 patients with MMC were treated at our hospital. The medical records, surgery reports, and X-rays from these patients were evaluated.


RESULTS
During the study period, 11% of the patients (n = 92) suffered one or more fractures. Risk analysis showed that patients with MMC and thoracic-level paralysis had a sixfold higher risk of fracture compared with those with sacral-level paralysis. Femoral-neck z-scores measured by dual-energy X-ray absorptiometry (DEXA) differed significantly according to the level of neurological impairment, with lower z-scores in children with a higher level of lesion. Furthermore, the rate of epiphyseal separation increased noticeably after cast immobilization. Mainly patients who could walk relatively well were affected.


CONCLUSIONS
Patients with thoracic-level paralysis represent a group with high fracture risk. According to these results, fracture and epiphyseal injury in patients with MMC should be treated by plaster immobilization. The duration of immobilization should be kept to a minimum (<4 weeks) because of increased risk of secondary fractures. Alternatively, patients with refractures can be treated by surgery, when nonoperative treatment has failed.
Akbar
Michael
M
Department of Orthopaedic Surgery, Trauma Surgery and Division of Spinal Cord Injury, University of Heidelberg, 69118 Heidelberg, Germany. michael.akbar@med.uni-heidelberg.de
Bresch
Bjoern
B
Raiss
Patric
P
Fürstenberg
Carl Hans
CH
Bruckner
Thomas
T
Seyler
Thorsten
T
Carstens
Claus
C
Abel
Rainer
R
D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D001860:Bone Plates; D002370:Casts, Surgical; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007103:Immobilization / Q000379:methods*; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D035002:Lower Extremity / Q000293:injuries; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome