Risk factors of long bone fracture in non-ambulatory cerebral palsy children.

ABSTRACT

OBJECTIVES: To identify the risk factors for long bone fractures in non-ambulatory cerebral palsy children. DESIGN. Case-control study. SETTING: A residential rehabilitation centre in Hong Kong. PATIENTS The fracture group comprised 19 (13 male, 6 female) cerebral palsy children aged 4 years 5 months to 18 years 11 months (mean, 10 years; standard deviation, 3 years 9 months), who had their first long bone fracture during the period June 1992 to May 2001 inclusive. The control group was composed of 90 (46 male, 44 female) concomitant cerebral palsy residents aged 6 years 1 month to 16 years 11 months (mean, 9 years 11 months; standard deviation, 2 years 4 months) with no history of long bone fracture. MAIN OUTCOME MEASURES: Presence of features considered relevant to the risk of fracture, namely anthropometry, feeding practice, orthopaedic surgery and duration of postoperative immobilisation, extremity contracture, anti-epileptic medications, and general health status in the 12 months prior to the fracture. RESULTS: Of the 19 fracture episodes, 18 occurred in the femur and one in the tibia/fibula. Multivariate analysis revealed that weight for age Z scores (adjusted odds ratio=0.41, 95% confidence interval, 0.19-0.86) and recent postoperative immobilisation (weeks) [adjusted odds ratio=1.35, 95% confidence interval, 0.97-1.89] were independent predictors for fracture occurrence. CONCLUSION: Early intervention targeting these risk factors may reduce the fracture risk in non-ambulatory cerebral palsy children.