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Journal of Orthopaedics and Traumatology

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Open Access 01-09-2010 | Original Article

Fractures in myelomeningocele

Authors: Michael Akbar, Bjoern Bresch, Patric Raiss, Carl Hans Fürstenberg, Thomas Bruckner, Thorsten Seyler, Claus Carstens, Rainer Abel

Published in: Journal of Orthopaedics and Traumatology | Issue 3/2010

Abstract

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.

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Title: Fractures in myelomeningocele
Authors: Michael Akbar
Bjoern Bresch
Patric Raiss
Carl Hans Fürstenberg
Thomas Bruckner
Thorsten Seyler
Claus Carstens
Rainer Abel
Publication date: 01-09-2010
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 3/2010
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-010-0102-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fractures in myelomeningocele

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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