Physeal injuries in myelomeningocele patients

Cuxart, A; Iborra, Jordi; Meléndez, Mark M.; Pagès, Esther

doi:10.1038/sc.1992.152

Cited by 8 publications

(9 citation statements)

References 13 publications

(6 reference statements)

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“…In the literature, figures ranging from 4% to 9% have been reported [8, 9, 27]. The relatively good walking ability of patients who suffered epiphyseal fractures is in line with observations made by Kumar et al.…”

Section: Discussionsupporting

confidence: 82%

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Fractures in myelomeningocele

Akbar

Bresch

Raiss

et al. 2010

J Orthopaed Traumatol

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BackgroundIn 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 methodsBetween 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.ResultsDuring 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.ConclusionsPatients 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.

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Section: Discussionsupporting

confidence: 82%

“…Epiphyseal fractures occur frequently in patients with MMC at rates of 4–9% [8, 9, 28] and can affect further bone growth. In contrast to other kinds of fractures, epiphyseal injuries mainly seem to affect those MMC children who can walk relatively well [24, 27].…”

Section: Introductionmentioning

confidence: 99%

Fractures in myelomeningocele

Akbar

Bresch

Raiss

et al. 2010

J Orthopaed Traumatol

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“…Roberts et al [99] suggested that repetitive microtrauma in non-sensitive limbs could produce micromovements in the zone of transformation of the cartilage, compromise the calcification process, and lead to the widening of the proximal non-calcified portion of the physis [99]. Failure to use orthoses for walking in patients requiring these aids constitutes a risk factor with regard to epiphysiolysis [100,101]. Kumar et al [21] reported that epiphyseal fractures occur most often in patients in a low lumbar ambulatory group, but they can occur at any level of motor paraplegia [21,101].…”

Section: Site Of Fracturementioning

confidence: 99%

“…Failure to use orthoses for walking in patients requiring these aids constitutes a risk factor with regard to epiphysiolysis [100,101]. Kumar et al [21] reported that epiphyseal fractures occur most often in patients in a low lumbar ambulatory group, but they can occur at any level of motor paraplegia [21,101]. James showed that due to the fragility of the bone, the insertions of the gastrocnemius and of the hamstrings around the knee may cause the displacement of the epiphyses when these mus-cles are spastic and the knee joint is repeatedly forced straight, as occurs during the application of splints [5].…”

Section: Site Of Fracturementioning

confidence: 99%

Update on bone fragility in spina bifida

Marreiros¹

2018

PRM

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BACKGROUND CONTEXT: Patients with spina bifida (SB) are at risk for pathological fractures and low bone mineral density (BMD). PURPOSE AND METHODS: This article reviews the literature and provides a comprehensive overview of how the characteristics of SB and its associated comorbidities intersect with bone fragility to identify possible pathophysiological mechanisms of fractures and low BMD. RESULTS: Bone fragility occurs early in the life of patients with SB as a result of a disturbance that determines changes in bone shape, quantity, and quality, as poor mineralization reduces bone stiffness. Bone fragility in SB occurs due to local and systemic factors and may be considered a state of impaired bone quality of multifactorial aetiology, with complex interacting influences of neurological, metabolic, and endocrinological origins and the presence of smaller bones. Bone fragility should be evaluated globally according to skeletal age and Tanner staging. The phases of the evolution of Charcot joints seem to intercept the evolution of epiphyseal fractures. Charcot arthropathy in SB may be initiated by the occurrence of repetitive trauma and fractures in epiphyseal and subepiphyseal regions, where there is a deficit of bone mineralization and greater bone mass deficits. CONCLUSION: Bone fragility in MMC potentially has a multifactorial neuro-endocrinological-metabolic-renal dimension, with smaller bones, lower bone mass, and mineralization deficits affecting bone strength.

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“…Copyright © Elisa López-Dolado OPROJ.000673. 7 (5).2020 but possibly be found a history of minor trauma [5], while physeal fractures are usually associated with repeated forces of stress that are thought to impact this growing part of the bone during walking [5,6], with no history of trauma maybe because of not wearing a suitable orthosis. Taking into account the lack of sensibility due the injury, these patients will not present pain and the only symptoms which may appear are swelling, local redness, local hyperthermia and sometimes high leukocyte count and high temperature, being the last two symptoms specially observed in case of metaphyseal and diaphyseal fractures, which can simulate an osteomyelitis or sarcoma [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Management of Femur Refractures in a 3-Year-Old Female with Myelomeningocele. A Case Report and Review of Literature

Madroñero-Mariscal

López-Dolado

2020

OPROJ

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Pathological Fractures (PF) affecting lower limbs have a prevalence ranging from 9% to 20% in children with myelomeningocele (MMC) [1]. It has been supported that the level of the injury involved has a great importance. On the one hand, the upper the level of the injury, the higher the risk of fracture, so thoracic-level injuries have 6 times higher risk of bone fracture, when comparing with sacral-level injuries [1]. On the other hand, Lock and Aronson [2] support that the localization of thoracic-level injuries usually involves femur fractures, while lumbar-level injuries mostly involve tibia fractures [2]; while Aliatakis et al.[3] find in their retrospective study of 210 patients that age at fracture has a stronger correlation with the fracture site than the level of the injury, being the fracture of the femur the most frequent one in the first five years of age and tibia and foot fractures after this age [3]. These fractures can affect different parts of the bone: metaphysis, diaphysis, or physis. It has been described different details in mechanism of injury, clinical presentation, treatment, and possible complications, depending on the affected site of the bone fracture.It is well known that after Spinal Cord Injury (SCI), it occurs pathological changes in bones and muscles below the neurological level of injury, such as a bone demineralization, muscle atrophy and increased adiposity, that lead to suffer osteopenia and osteoporosis, and therefore it increases the risk of bone fracture [4]. In metaphyseal and diaphyseal fractures, it can rarely,

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Physeal injuries in myelomeningocele patients

Cited by 8 publications

References 13 publications

Fractures in myelomeningocele

Fractures in myelomeningocele

Update on bone fragility in spina bifida

Management of Femur Refractures in a 3-Year-Old Female with Myelomeningocele. A Case Report and Review of Literature

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