Fractures in myelomeningocele.

Journal Article (Journal Article)

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. MATERIALS AND 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.

Full Text

Duke Authors

Cited Authors

  • Akbar, M; Bresch, B; Raiss, P; Fürstenberg, CH; Bruckner, T; Seyler, T; Carstens, C; Abel, R

Published Date

  • September 2010

Published In

Volume / Issue

  • 11 / 3

Start / End Page

  • 175 - 182

PubMed ID

  • 20721596

Pubmed Central ID

  • PMC2948122

Electronic International Standard Serial Number (EISSN)

  • 1590-9999

Digital Object Identifier (DOI)

  • 10.1007/s10195-010-0102-2


  • eng

Conference Location

  • Italy