Fracture characteristics by age, sex, and ambulatory status among individuals with cerebral palsy: a descriptive study. Issue 17 (14th August 2022)

• Record Type: Journal Article
• Authors: Kannikeswaran, Sanjana; French, Zachary P.; Walsh, Kevin; Swallow, Jennylee; Caird, Michelle S.; Whitney, Daniel G.
• Is Part Of: Disability and rehabilitation. Volume 44:Issue 17(2022)
• Page Start: 4806
• Page End: 4812
• Publication Date: 2022-08-14
• Subjects: Cerebral palsy -- fracture -- characteristics; People with disabilities -- Periodicals; Rehabilitation -- Periodicals; 617.03
• DOI: 10.1080/09638288.2021.1921860
• Languages: English
• ISSNs: 0963-8288

Abstract

Abstract: Purpose: To evaluate clinically relevant fracture characteristics by age, sex, and ambulatory status among individuals with cerebral palsy. Methods: Fracture location, energy of fracture, and activities that lead to a fracture were assessed among a clinic-based sample of children (0–17 years; n = 57) and adults (18–70 years; n = 58) with cerebral palsy that sustained a fracture by sex and gross motor function classification system (GMFCS) I–III vs. IV/V. Results: Proportion of fractures that were low-energy was 67–99% for children and 69–84% for adults. ∼2/3rds of fractures were at the lower extremities, with the distal femur being the most common site for children (44%) and the foot/ankle for adults (40%); however, there were age, sex, and ambulatory effects, such that 43% of adults GMFCS IV/V and 32% of women had a distal femur fracture. GMFCS I–III were more likely to fracture from functionally complex activities, while GMFCS IV/V were more likely to fracture from wheelchair/transfers/limb-stuck and incidental findings. Conclusions: The majority of fractures were low-energy and occurred in the lower extremities, with effects by age, sex, and GMFCS. Activities that led to a fracture also differed by age and GMFCS, which can be used to design fracture prevention interventions in addition to bolstering skeletal mass and architecture. Implications for rehabilitation: Skeletal fragility is a major problem for individuals with cerebral palsy (CP) across the lifespan leading to an increased risk of fragility fractures. Rehabilitation is a prime clinical intervention to prevent fractures from occurring and improving post-fracture healing and function; yet, effective rehabilitation interventions require knowledge of fracture characteristics, such as where fractures are occurring and the activities that lead to the fracture event specific to individuals with CP. Using a clinic-based sample of 0–70 year olds with CP, we describe salient fracture characteristics based on age, sex, and ambulatory status to enhance translation into clinical and rehabilitation practice.