Pathological Fractures in Patients with Myelomeningocele

Background: Pathological fractures are common in patients with myelomeningocele (MMC). No standardized and effective preventive measure has been proposed. The purpose was to identify risk factors and causal relationships to deduce successful prevention strategies.

Methods: Based on medical records, we built a database including all patients treated at our center between 1976 and 2016.

Results: Twenty-seven out of 209 patients (12.9%) sustained altogether 53 pathological fractures. Average age was 6.6 years with two frequency peaks between 1 and 5 years and 10 and 12 years. Particularly patients with higher lesion levels were affected. All fractures were located in the lower limbs and, during the first 5 years, 84% in the femur. 34% of patients had experienced an immobilizing event during the preceding 3 months, mostly orthopedic surgery or fracture treatment. Based on our results, we can distinguish two main groups of patients: (1) Children with first fracture before the age of 5 years with commonly high lesion level developed multiple fractures during a shorter time period, and did not experience further fractures after an average of 3.6 years. (2) Children with a first fracture after the age of 5 years frequently had fewer fractures, but these occurred during a longer period of time. The time of verticalization did not have any effect on the age of fracture occurrence.

Conclusion: Preschool and prepubescent age represent two vulnerable phases. Children with early pathological fractures do not show further fractures after preschool age. The results can help to develop pharmacological and physiotherapy prevention concepts.