Epidemiology of fractures in children with cerebral palsy: a Swedish population-based registry study
Gustaf Linton1, Gunnar Hägglund2, Tomasz Czuba1
1Faculty of Medicine, Lund University, Lund, Sweden.
Insights
Children with cerebral palsy (CP) face similar fracture risks as peers, but epilepsy significantly increases this danger. Fracture locations vary by Gross Motor Function Classification System (GMFCS) level, with femur fractures common in severe cases.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Epidemiology
Background:
- Children with cerebral palsy (CP) present diverse fracture risks and sites compared to typically developing children.
- Understanding these epidemiological differences is crucial for targeted prevention and care.
Purpose of the Study:
- To analyze the epidemiology of fractures in a comprehensive population of children with CP.
- To identify risk factors and common fracture sites in children with CP.
Main Methods:
- Retrospective registry study using data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register.
- Inclusion of children with CP born between 2000-2015, recording Gross Motor Function Classification System (GMFCS) level, fractures, fracture sites, and epilepsy diagnosis up to 2018.
- Calculation of hazards and hazard ratios for first-time fractures.
Main Results:
- Out of 3,902 children with CP, 9.4% experienced at least one fracture before age 16.
- The hazard for fracture was seven times higher in children with epilepsy.
- Fracture incidence was not significantly linked to sex or GMFCS level, but fracture sites varied: upper extremities in lower GMFCS levels, femur in GMFCS level V.
Conclusions:
- Children with CP have a similar overall fracture risk to typically developing children, but comorbid epilepsy elevates this risk.
- Fracture patterns differ by GMFCS level; upper extremity fractures are common in lower GMFCS levels, while lower extremity and femur fractures are more prevalent in higher GMFCS levels (IV-V) and in those with epilepsy.
Background:
Children with cerebral palsy (CP) form a heterogeneous group and may have risk or protective factors for fractures compared with typically developing children. The fracture sites may also differ from those of children who do not have CP. We analyzed the fracture epidemiology in a total population of children with CP.
Methods:
This was a retrospective registry study based on data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register. All children in the CPUP born in 2000-2015 were included. The Gross Motor Function Classification System (GMFCS) level, reported fractures, fracture site, and epilepsy diagnosis were recorded up to 2018. Hazards and hazard ratios were calculated for first-time fractures.
Results:
Of the 3,902 participants, 368 (9.4%) had at least one reported fracture. The cumulative risk of sustaining a fracture before age 16 years was 38.3% (95% confidence interval 33.9-42.4). The hazard for fracture was 7 times higher in children with epilepsy. The overall fracture incidence was not statistically significantly related to sex or GMFCS level. Fractures in the upper extremities were most prevalent in children with a lower GMFCS level, and femoral fractures were most prevalent in children at GMFCS level V. Most fractures occurred in early childhood and after 8 years of age.
Conclusions:
Children with CP were at similar risk of sustaining fractures as typically developing children, but the risk was higher in children with comorbid epilepsy. Fractures occurred in children at GMFCS levels I-III at sites similar to those for typically developing children; fractures in the upper extremities were the most frequent. Children at GMFCS levels IV or V and those with epilepsy were more likely to have a fracture in the lower extremities, and the femur was the most frequent site.
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