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Epiphyseal separations in spastic cerebral palsy.

Alaric J Aroojis1, Shreyash M Gajjar, Ashok N Johari

  • 1Orthopaedic Surgery, Bai Jerbai Wadia Hospital, Mumbai, India. aaroojis@vsnl.net

Journal of Pediatric Orthopedics. Part B
|April 7, 2007
PubMed
Summary

Severe spastic cerebral palsy (SCP) patients can experience scurvy-induced epiphyseal separations. Prompt vitamin C treatment and splinting lead to rapid healing and excellent remodeling in these children.

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Area of Science:

  • Pediatric Orthopedics
  • Nutritional Deficiencies
  • Neurology

Background:

  • Children with severe spastic cerebral palsy (SCP) often present with metaphyseal and diaphyseal fractures.
  • Epiphyseal separations have not been previously documented in this patient population.
  • Nutritional deficiencies, particularly vitamin C deficiency (scurvy), can affect bone health.

Purpose of the Study:

  • To report and characterize epiphyseal separations in children with severe spastic quadriplegic cerebral palsy.
  • To identify scurvy as the underlying cause of these injuries.
  • To evaluate the treatment outcomes and prognosis of these specific injuries.

Main Methods:

  • Case series reporting on four children with severe spastic quadriplegic cerebral palsy.
  • Clinical and radiological assessment to diagnose epiphyseal separations and scurvy.
  • Treatment involved vitamin C supplementation and splintage.

Main Results:

  • Nine epiphyseal separations were identified, involving the distal femur and proximal humerus.
  • Clinico-radiological findings confirmed scurvy as the etiology.
  • Treatment with vitamin C and splintage resulted in rapid healing and excellent bone remodeling.
  • Prognosis was favorable, contrasting with physeal injuries in other conditions.

Conclusions:

  • Scurvy should be considered in the differential diagnosis of epiphyseal slips in children with severe spastic cerebral palsy.
  • Routine vitamin C supplementation is recommended for malnourished, nonambulant children with SCP.
  • Epiphyseal separations due to scurvy in this population have a good prognosis with appropriate management.