Fracture characteristics by age, sex, and ambulatory status among individuals with cerebral palsy: a descriptive study

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.

Keywords:

• Cerebral palsy
• fracture
• characteristics

Acknowledgments

The funding source had no role in the design or conduct of the study; collect, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund and the American Academy for Cerebral Palsy and Developmental Medicine.