Risk factors of long bone fracture in non-ambulatory cerebral palsy children
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Published on: January 29, 2018
C H Ko1, P W T Tse, A K H Chan
1Developmental Disabilities Unit, Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Hong Kong. koch@ha.org.hk
Insights
Low weight for age and recent immobilization increase long bone fracture risk in children with cerebral palsy (CP). Early interventions targeting these factors can help prevent fractures in non-ambulatory CP patients.
Area of Science:
- Pediatrics
- Orthopedics
- Neurology
Background:
- Cerebral palsy (CP) is a group of disorders affecting movement and posture.
- Non-ambulatory children with CP are at higher risk for long bone fractures.
- Identifying specific risk factors is crucial for fracture prevention.
Purpose of the Study:
- To identify risk factors for long bone fractures in non-ambulatory children with cerebral palsy.
- To inform targeted interventions for fracture risk reduction.
Main Methods:
- A case-control study was conducted at a residential rehabilitation center.
- 19 children with CP who experienced long bone fractures (case group) were compared to 90 children with CP without fractures (control group).
- Data collected included anthropometry, feeding practices, orthopedic surgery history, immobilization duration, contractures, anti-epileptic medication use, and general health status.
Main Results:
- The femur was the most common site of fracture (18 out of 19 episodes).
- Multivariate analysis identified low weight-for-age Z scores (OR=0.41) as a protective factor.
- Recent postoperative immobilization (weeks) was found to be an independent predictor of fracture occurrence (OR=1.35).
Conclusions:
- Low weight-for-age and recent immobilization are significant risk factors for long bone fractures in non-ambulatory children with cerebral palsy.
- Early intervention strategies focusing on these modifiable risk factors are recommended.
- These interventions may significantly reduce fracture incidence in this vulnerable population.
Objectives:
To identify the risk factors for long bone fractures in non-ambulatory cerebral palsy children. DESIGN. Case-control study.
Setting:
A residential rehabilitation centre in Hong Kong.
Patients:
The fracture group comprised 19 (13 male, 6 female) cerebral palsy children aged 4 years 5 months to 18 years 11 months (mean, 10 years; standard deviation, 3 years 9 months), who had their first long bone fracture during the period June 1992 to May 2001 inclusive. The control group was composed of 90 (46 male, 44 female) concomitant cerebral palsy residents aged 6 years 1 month to 16 years 11 months (mean, 9 years 11 months; standard deviation, 2 years 4 months) with no history of long bone fracture.
Main Outcome Measures:
Presence of features considered relevant to the risk of fracture, namely: anthropometry, feeding practice, orthopaedic surgery and duration of postoperative immobilisation, extremity contracture, anti-epileptic medications, and general health status in the 12 months prior to the fracture.
Results:
Of the 19 fracture episodes, 18 occurred in the femur and one in the tibia/fibula. Multivariate analysis revealed that weight for age Z scores (adjusted odds ratio=0.41, 95% confidence interval, 0.19-0.86) and recent postoperative immobilisation (weeks) [adjusted odds ratio=1.35, 95% confidence interval, 0.97-1.89] were independent predictors for fracture occurrence.
Conclusion:
Early intervention targeting these risk factors may reduce the fracture risk in non-ambulatory cerebral palsy children.
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