Orthopedic Complications
Fractures
The incidence of fractures associated with minimal trauma is increased in children with cerebral palsy, spina bifida, and Duchenne muscular dystrophy (53). This is related to reduced bone mineral density secondary to immobilization or limited mobility.
Children with cerebral palsy or Duchenne muscular dystrophy with an acute fracture typically present with pain and/or irritability. However, children with spina bifida or a spinal cord injury may only present with swelling of the limb due to their lack of sensation. Radiographs should be utilized when swelling of a limb is present, even when no trauma history is elicited.Treatment of fractures in children with disabilities varies, depending on the diagnosis, type, and location of the fracture. Casting of a limb in a child may depend on his or her degree of mobility. In other words, in a child who is wheelchair-dependent, a bulky splint may be applied. This is especially true for a child who is insensate, since a plaster or fiberglass cast may lead to pressure sores. Prophylactic treatment of reduced bone mineral density in children with special health care needs is controversial and should be addressed by a specialist in disorders of bone metabolism (54).
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