Treatment of femur fractures in children with cerebral palsy

Abstract

Purpose: Children with cerebral palsy may have low bone density stemming from various etiologies and are, thereby, at risk for fractures. The treatment of femur fractures in children with cerebral palsy may need to be tailored to address the management of spastic muscle tone and multiple medical co-morbidities.

Methods: Our study is a retrospective review that evaluates the treatment of 47 femur fractures in children with cerebral palsy in both ambulatory and non-ambulatory patients.

Results: Thirty-two fractures in non-ambulators were treated non-operatively, 11 of which resulted in malunions and five developed pressure sores. Six fractures in non-ambulators were treated operatively, one of which resulted in a malunion. In ambulators, five fractures were treated non-operatively; one of these fractures lost reduction after 2 weeks and required surgical intervention. One of four fractures in ambulators treated operatively developed a malunion.

Conclusion: Our study results suggest that femur fractures in children with cerebral palsy can be treated non-operatively; however, because of the high risk of malunion in this patient population, fracture alignment needs to be followed closely during healing. Careful attention during casting is necessary to prevent pressure sores. Strong consideration should be given to initial operative treatment in ambulatory patients in order to preserve function.

Fig. 1

Fracture through a blade plate 6 months following surgical intervention after a fall from bed. The initial osteotomy had been performed 2 years prior to the fracture

Fig. 2

a, b Initial injury films, anteroposterior and lateral views, of the distal femur fracture in a non-ambulator with cerebral palsy subtype spastic quadriparesis. c, d Fracture 6 weeks post-injury