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Updated: Jun 10, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Fractures in myelomeningocele
Michael Akbar1, Bjoern Bresch, Patric Raiss
1Department of Orthopaedic Surgery, Trauma Surgery and Division of Spinal Cord Injury, University of Heidelberg, 69118 Heidelberg, Germany. michael.akbar@med.uni-heidelberg.de
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.
Insights
Patients with myelomeningocele (MMC) and thoracic paralysis face a significantly higher risk of fractures. Immobilization for fractures should be brief to minimize secondary fracture risks.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Myelomeningocele (MMC) frequently leads to fractures in paralyzed extremities, impacting patient mobility.
- Understanding fracture frequency and risk factors in MMC patients is crucial for improving care.
Purpose of the Study:
- To determine the incidence of fractures in a cohort of myelomeningocele patients.
- To identify trends and risk factors associated with fractures in this population.
Main Methods:
- Retrospective cross-sectional study of 862 myelomeningocele patients treated between March 1988 and June 2005.
- Evaluation of medical records, surgical reports, and X-rays.
Main Results:
- 11% of patients experienced one or more fractures.
- Thoracic-level paralysis correlated with a sixfold increased fracture risk compared to sacral-level paralysis.
- Lower femoral-neck z-scores (indicating reduced bone density) were associated with higher lesion levels; cast immobilization increased epiphyseal separation risk.
Conclusions:
- Thoracic-level paralysis identifies a high-risk group for fractures in myelomeningocele patients.
- Plaster immobilization is recommended for fractures and epiphyseal injuries, with durations under 4 weeks to mitigate secondary fracture risk.
- Surgery is an alternative for refractory cases where nonoperative treatment fails.
