Extremity fractures in children with neuromuscular disease

This report discusses the occurrence and management of fractures seen in 30 children with neuromuscular disorders. Twenty fractures were seen in 17 ambulatory patients, ages 5 to 16. Twelve of the patients in this group had Duchenne muscular dystrophy (DMD), 3 had spinal muscular atrophy (SMA) and 2 had Charcot--Marie--Tooth (CMT) disease. Treatment consists of reduction of the fractures followed by immobilization of the extremities; however, continuation of everyday activities, including ambulation, should be emphasized. In fact, five patients ceased walking as a direct result of immobilization following fracture. Sixteen fractures were seen in 13 non-ambulatory patients, ages 4 to 19. These fractures were generally caused by very small forces; the fractures were rarely displaced. Eight of the fractures in osteoporotic and contracted knee joints occurred in either the distal femur or proximal tibia. Functional loss can be minimized by splinting until the patient no longer complains of pain. Splinting should be followed by rapid return to full activity.