Article

The morbidity associated with osteoporosis and fractures in children and
adolescents with spina bifida highlights the importance of osteoporosis
prevention and treatment in these patients. The aim of this study was to examine
the occurrence and pattern of bone fractures in paediatric patients with spina bifida. METHOD: We reviewed the data of all paediatric patients with spina bifida
who were treated in our centre between 1999 and 2008. RESULTS: One hundred and
thirteen patients were included in the study (63 females, 50 males; mean age 10y
8mo, SD 4y 10mo, range 6mo-18y). The motor levels were thoracic in six, upper
lumbar in 22, lower lumbar in 42, and sacral in 43 patients. Of the 113 patients,
58 (51.3%) had shunted hydrocephalus. Thirty-six (31.8%) were non-ambulatory
(wheelchair-dependent [unable to self-propel wheelchair] n=3,
wheelchair-independent [able to self-propel wheelchair] n=33), 13 were partial
ambulators, 61 were full ambulators, and three were below the age of walking.
Forty-five fractures were reported in 25 patients.
The distal femur was the most
common fracture site. Statistical analyses showed that patients with higher
levels of involvement and in wheelchairs had a significantly increased risk of
having a [corrected] fracture (p<0.001). Spontaneous fractures were the principal
mechanism of injury, and an association was identified between fracture
mechanism, type of ambulation, and lesion level: the fractures of patients with
higher levels of motor functioning and those in wheelchairs were mainly
pathological (p=0.01). We identified an association between risk of a second
fracture, higher motor level lesion, and non-ambulation. There was an increased
risk of having a second fracture after a previous spontaneous fracture (p=0.004).
INTERPRETATION: Data in this study indicate a high prevalence of fractures in
patients with spina bifida.

Langue : ANGLAIS