The treatment of femoral fractures in children with cerebral palsy.

Abstract

OBJECTIVE:

The purpose of this study is to retrospectively evaluate a group of children affected by cerebral palsy with a recent femoral fracture, and to analyse the results and complications in relation to the treatment used.

MATERIALS AND METHODS:

The analysis was performed on 36 children (21 M, 15 F, 8-14 years old) with cerebral palsy (7 diplegia, 28 tetraparesis, 1 hemiplegia) with a metaphyseal or a diaphyseal femoral fracture. The patients were subdivided into two groups according to their Gross Motor Function Classification System (GMFCS) level: level 2-3 (9 patients) and level 4-5 (27 patients), evaluating the presence of complications and malunions for each group at the end of each follow up.

RESULTS:

The fractures were displaced in 24 patients and nondisplaced in 12 patients. In 26 cases the treatment involved a closed reduction and immobilisation in a long leg hip spica cast for 7 weeks, while in 10 cases the treatment involved an open reduction-internal fixation (ORIF) followed by a 3-week period in a plaster coated fracture bandage.

CONCLUSIONS:

Taking into consideration the maximum possible recovery of function, an ORIF is preferable to prevent malunion, particularly in distal metaphysis and distal shaft fractures. In the GMFCS level 2-3 patients, surgery has allowed to recover, or at least maintain, the pre-fracture functional level, while in patients with GMFCS level 4-5, it has allowed to reduce the immobilisation times and prevent the development of decubitus lesions.

• Authors: P Persiani, M Murgia, F M Ranaldi, O Mazza, M Mariani, M Crostelli, C Villani
• Journal: La Clinica terapeutica (Clin Ter) 2018 Jan-Feb Vol. 169 Issue 1 Pg. e18-e22 ISSN: 1972-6007 [Electronic] Italy
• PMID: 29446787 (Publication Type: Journal Article)

Topics

• Adolescent
• Casts, Surgical
• Cerebral Palsy (complications)
• Child
• Female
• Femoral Fractures (complications, therapy)
• Fracture Fixation, Internal
• Humans
• Immobilization
• Male
• Retrospective Studies
• Treatment Outcome