Fractures in Children With Cerebral Palsy: A Systematic Review.

Area of Science:

• Pediatric Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Children with cerebral palsy (CP) classified under Gross Motor Function Classification System (GMFCS) levels III-V are at increased risk for reduced bone strength and low-trauma fractures.
• Understanding fracture patterns and risk factors is crucial for this vulnerable population.

Purpose of the Study:

• To systematically review and identify fracture rates, common locations, and associated risk factors in children with CP (GMFCS III-V).

Main Methods:

• A systematic literature search was conducted across five major databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO) up to November 2024.
• Studies involving children under 18 with CP (GMFCS III-V) and reporting baseline fracture data were included, with methodological quality assessed using the Newcastle Ottawa Scale.

Main Results:

• Thirty studies were included, revealing fracture rates from 2.2 to 4.8 per 100 child-years and a lifetime prevalence of 9.4% to 15.5%.
• Lower extremity fractures, particularly of the femur (54.1%), were most common. High-quality evidence identified low bone mineral density, epilepsy, and weight imbalance as key risk factors.

Conclusions:

• Children with CP (GMFCS III-V) are susceptible to fragility fractures in the lower extremities.
• Identified modifiable risk factors include poor nutrition, weight imbalance, uncontrolled seizures, and insufficient weight-bearing activity.
• Variability in study quality and reporting necessitates cautious interpretation of findings.