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Pathologic fractures in severely handicapped children and young adults
1Division of Pediatric Orthopaedics, Henry Ford Hospital, Detroit, Michigan 48202.
Insights
Vitamin D abnormalities are common in severely handicapped individuals with fractures, particularly those with multiple breaks. Supplementation can reduce fracture incidence in deficient patients.
Area of Science:
- Pediatrics
- Orthopedics
- Endocrinology
Background:
- High incidence of vitamin D abnormalities (42%) observed in severely handicapped children and young adults with fractures.
- Fractures predominantly affect the lower extremity and typically heal with simple immobilization.
Purpose of the Study:
- To investigate the prevalence of vitamin D abnormalities in severely handicapped individuals experiencing fractures.
- To differentiate fracture causes in patients with normal versus abnormal vitamin D levels.
Main Methods:
- Retrospective analysis of fracture cases in severely handicapped children and young adults.
- Assessment of vitamin D levels and fracture patterns.
- Evaluation of fracture etiology, including trauma and potential child abuse.
Main Results:
- Vitamin D abnormalities are prevalent (42%) in this population, especially with multiple fractures.
- Lower extremity fractures are common and heal well with immobilization.
- Normal vitamin D levels necessitate ruling out significant trauma or child abuse.
- Vitamin D supplementation effectively reduces fracture incidence in deficient patients.
Conclusions:
- Vitamin D deficiency is a significant factor in fractures among severely handicapped individuals.
- Prompt diagnosis and supplementation of vitamin D are crucial for fracture prevention.
- Distinguishing between accidental fractures and abuse is vital, guided by vitamin D status.
Abstract:
The incidence (42%) of vitamin D abnormalities is high in severely handicapped children and young adults who sustain fractures, especially those who sustain multiple fractures. Fractures occur primarily in the lower extremity and heal with simple immobilization. In patients with normal vitamin D levels, a history of a significant traumatic event should be identified and child abuse ruled out. Vitamin D-deficient patients respond to nutritional and vitamin D supplementation, with decreased fracture incidence.