Related Experiment Video
Updated: Jan 30, 2026
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Fractures in children with cerebral palsy: a total population study
Ulrika Uddenfeldt Wort1, Eva Nordmark, Philippe Wagner
1Department of Clinical Sciences (Malmö), Social Medicine and Global Health, Lund University, Malmö, Sweden. ulrika.uddenfeldt_wort@med.lu.se
Insights
Children with severe cerebral palsy (CP) face increased fracture risks, especially those with stunted growth or not using standing devices. Early nutrition and exercise can help prevent fractures in these children.
Area of Science:
- Pediatrics
- Orthopedics
- Neurology
Background:
- Children with cerebral palsy (CP) exhibit varying physical abilities, impacting their susceptibility to fractures.
- Understanding fracture risk factors in CP is crucial for targeted preventative strategies.
Purpose of the Study:
- To analyze factors associated with fractures in children with cerebral palsy (CP) across different Gross Motor Function Classification System (GMFCS) levels.
- To identify specific risk factors for fractures in children with CP, particularly in more severe functional classifications.
Main Methods:
- An epidemiological retrospective study of 536 children with CP (born 1990-2005).
- Data collected included CP type, GMFCS level, gastrostomy, anthropometrics, standing device use, antiepileptic drug (AED) therapy, and fracture history.
- Children were categorized into GMFCS levels I-III (n=384) and IV-V (n=152).
Main Results:
- Fracture risk in the overall CP population was similar to typically developing children.
- Children in GMFCS levels I-III showed no significant association between fractures and studied risk factors.
- In GMFCS levels IV-V, antiepileptic drug (AED) therapy doubled fracture risk (p=0.004).
- Stunted growth (height for age <-3 SD) and non-use of standing devices significantly increased fracture risk (AIRR 4.16, p=0.011 and AIRR 3.66, p=0.010, respectively).
- Gastrostomy feeding showed conflicting results: reduced risk with trauma, increased risk without trauma.
Conclusions:
- Children in GMFCS levels I-III have fracture incidence and patterns similar to typically developing children.
- Children in GMFCS levels IV-V with stunted growth face increased fracture risk.
- Use of standing devices was associated with a fourfold reduction in fractures without trauma.
- Regular weight-bearing exercises and adequate early nutrition are recommended to prevent fractures in severe CP.
Aim:
To analyse factors associated with fractures in children with cerebral palsy (CP) in different levels of Gross Motor Function Classification System (GMFCS).
Method:
This was an epidemiological retrospective study of a total population of 536 children (214 females, 322 males) with CP born between 1990 and 2005. CP type was unilateral spastic (n=159), bilateral spastic (n=225), ataxic (n=60), dyskinetic (n=80), and mixed type (n=12); 384 children were in Gross Motor Function Classification Scale (GMFCS) levels I-III and 152 children were in GMFCS levels IV-V. Data were collected for a 9-year period on sex, CP-type, GMFCS level, gastrostomy, height, weight, the use of a standing device, antiepileptic drug (AED) therapy, and fractures.
Results:
The risk of fracture in the total population of children with CP was similar to that for typically developing children. The risk for fractures of those in GMFCS levels I-III was not significantly associated with any of the studied risk factors. The risk of fractures for those in GMFCS levels IV-V on AED therapy was a twofold increase (p=0.004). The risk for fractures without trauma in children with stunted growth (height for age <-3 SD) and those who did not use standing devices was significantly increased: adjusted incidence rate ratio (AIRR) 4.16 (p=0.011) and 3.66 (p=0.010) respectively. Results regarding gastrostomy feeding for those in GMFCS levels IV-V were conflicting: a gastrostomy was associated with a reduced risk of fractures with trauma, but with increased risk of fractures without trauma (AIRR 0.10, p=0.003 and 4.36, p=0.012) respectively.
Interpretation:
Children in GMFCS levels I-III had a similar incidence and pattern for fractures as normally developing children. Those in GMFCS levels IV-V had stunted growth, often a sign of longstanding undernourishment, and were associated with an increased risk of fractures. Children using standing devices had a fourfold reduction of fractures without trauma. Regular loading exercises and early adequate nutritional intake could prevent fractures in severe CP.
More Related Videos
08:24Author Spotlight: Exploring the Potential of Massage Therapy in Cerebral Palsy Using Animal Models
Published on: August 11, 2023
08:26Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Related Concept Videos
01:25What is Population Genetics?
00:30What are Populations and Communities?
02:04Conservation of Small Populations
00:57Population Growth
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:12Total Voids in Concrete