Features of treatment of hip fractures in children with severe forms of cerebral palsy

Abstract

BACKGROUND: The increased incidence of fractures in children with severe spastic paralysis due to low-energy trauma is associated with poor bone mineral density, lack of adequate verticalization, and use of antiepileptic drugs. The most frequent localization of fractures is the lower extremities, especially the femur. The increased frequency of traumatization at this level correlates with a high level of impairment of global motor functions — levels IV–V according to the Gross Motor Function Classification System. CLINICAL CASE DESCRIPTION: Surgical treatment of a femur fracture in a child with cerebral palsy was performed. Given the ineffectiveness of repositioning due to spasticity of the adductor and iliopsoas muscles, one-stage repositioning of the fragments, myotomy and osteosynthesis were performed. Treatment of fractures in 3 more children with cerebral palsy was also described in the article. The results were evaluated at least 6 months after the end of treatment. Surgical treatment is preferable, providing sufficient stabilization of the fracture, reducing the time of plaster immobilization and the probability of associated risks, as well as preventing delayed consolidation and nonunions. CONCLUSION: Elastic intramedullary reinforcement used in the treatment of osteopenic fractures is a method of preventing fracture recurrence in the distant period or preventing significant fragment displacement.