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Fractures in myelomeningocele.

dc.contributor.author Abel, R
dc.contributor.author Akbar, M
dc.contributor.author Bresch, B
dc.contributor.author Bruckner, T
dc.contributor.author Carstens, C
dc.contributor.author Fürstenberg, CH
dc.contributor.author Raiss, P
dc.contributor.author Seyler, Thorsten M
dc.coverage.spatial Italy
dc.date.accessioned 2015-08-12T18:11:23Z
dc.date.issued 2010-09
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/20721596
dc.identifier.uri https://hdl.handle.net/10161/10374
dc.description.abstract BACKGROUND: In patients with myelomeningocele (MMC), a high number of fractures occur in the paralyzed extremities, affecting mobility and independence. The aims of this retrospective cross-sectional study are to determine the frequency of fractures in our patient cohort and to identify trends and risk factors relevant for such fractures. MATERIALS AND METHODS: Between March 1988 and June 2005, 862 patients with MMC were treated at our hospital. The medical records, surgery reports, and X-rays from these patients were evaluated. RESULTS: During the study period, 11% of the patients (n = 92) suffered one or more fractures. Risk analysis showed that patients with MMC and thoracic-level paralysis had a sixfold higher risk of fracture compared with those with sacral-level paralysis. Femoral-neck z-scores measured by dual-energy X-ray absorptiometry (DEXA) differed significantly according to the level of neurological impairment, with lower z-scores in children with a higher level of lesion. Furthermore, the rate of epiphyseal separation increased noticeably after cast immobilization. Mainly patients who could walk relatively well were affected. CONCLUSIONS: Patients with thoracic-level paralysis represent a group with high fracture risk. According to these results, fracture and epiphyseal injury in patients with MMC should be treated by plaster immobilization. The duration of immobilization should be kept to a minimum (<4 weeks) because of increased risk of secondary fractures. Alternatively, patients with refractures can be treated by surgery, when nonoperative treatment has failed.
dc.language eng
dc.relation.ispartof J Orthop Traumatol
dc.relation.isversionof 10.1007/s10195-010-0102-2
dc.subject Adolescent
dc.subject Age Distribution
dc.subject Analysis of Variance
dc.subject Bone Plates
dc.subject Casts, Surgical
dc.subject Chi-Square Distribution
dc.subject Child
dc.subject Child, Preschool
dc.subject Cross-Sectional Studies
dc.subject Female
dc.subject Femoral Neck Fractures
dc.subject Follow-Up Studies
dc.subject Fracture Fixation, Internal
dc.subject Fracture Healing
dc.subject Humans
dc.subject Immobilization
dc.subject Incidence
dc.subject Injury Severity Score
dc.subject Logistic Models
dc.subject Lower Extremity
dc.subject Male
dc.subject Meningomyelocele
dc.subject Radiography
dc.subject Retrospective Studies
dc.subject Risk Assessment
dc.subject Sex Distribution
dc.subject Tibial Fractures
dc.subject Time Factors
dc.subject Treatment Outcome
dc.title Fractures in myelomeningocele.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/20721596
pubs.begin-page 175
pubs.end-page 182
pubs.issue 3
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Orthopaedics
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 11
dc.identifier.eissn 1590-9999


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