Epiphyseal Detachment Fractures in Patients with Spina Bifida: About a Case with Review of the Literature

N. Belmehboul *

Corresponding Author: N. Belmehboul, EPH Brothers Meghlaoui, Mila

Copy Right: © 2022 N. Belmehboul, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: December 30, 2022

Published Date: January 10, 2023

Abstract

Epiphyseal detachment fractures of the distal end of the femur are relatively common in patients with spinabifida, but they most often go unnoticed due to sensory disturbances and/or minimal displacement of the fractures in this type of patient. These patients present with a hot tumefaction of the knee often with general inflammatory signs, but without pain or notion of trauma. We report a case of epiphyseal detachment fracture of the distal end of the femur in a 06-year-old child with myelomeningocele.

Key Words: Epiphyseal detachment; spina bifida; knee swelling.

Introduction

Epiphyseal detachment fractures in patients with myelomeningocele are common complications [2,4]. They are due to sensory disorders and osteoporosis. They occur in 10 to 30% of patients [1], with knee involvement in 50% of cases [2].

These fractures generally manifest themselves in the form of a hot tumefaction with sometimes fever and hyperleucocytosis [1,2,4]. They are rarely painful and without notion of trauma [4].

An infection (arthritis, osteomyelitis), or even a sarcoma can be evoked, which delays the diagnosis of the fracture [1,3].

Observation:

Our 6-year-old male patient, carrier of myelomeningocele (figure 1), and not walking, was urgently hospitalized at the level of the pediatric department for a painless hot swelling of the left knee without notion of trauma and without deformation visible from the knees (figure 2), with Hyperleukocytosis. The diagnosis of acute osteoarthritis of the knee was suspected and the patient was put on double intravenous antibiotic therapy.
 

On the 7th day of his hospitalization, a conventional X-ray of both knees was made and which objectified an epiphyseal detachment fracture in the process of consolidation of the distal end of the femur (figure 3).

Our treatment was immobilization of the left lower limb with a cruropedial cast for 1 month.

The radio-clinical evolution after one month of immobilization was marked by the disappearance of the swelling of the knee with a consolidation of the fracture and the formation of a hypertrophic callus. (Figure 4)

Discussion

In children with spina bifida, the most common fractures are epiphyseal fractures of the femur [1,3], and the side most affected is the one with sensory disorders [2].

The diagnosis of the fracture must always be evoked in front of any warm swelling [2,4]. Most often there is no notion of direct violent trauma in these patients, moreover one can find the notion of trivial repeated trauma (falls, aggressive manipulation of the limbs, etc.) [4].

The radiological changes observed in these patients (hypertrophic callus) and the presence of inflammatory signs may evoke other diagnoses (osteomyelitis, osteosarcoma, etc.), and lead to unnecessary procedures such as puncture and biopsy [1 ,2,3].

The treatment of these fractures consists of immediate plaster immobilization to prevent displacement of the fracture and its consolidation into a malunion [4], and the duration of immobilization should be short so as not to aggravate osteoporosis and avoid stiffness. articular.

Conclusion

Children with myelomeningocele have a potential risk of fracture of the lower limbs due to osteoporosis and sensory disturbances. These fractures can often go unnoticed.

It is important to know the clinical and radiological aspect of fractures in this type of patient in order to proceed with appropriate treatment and avoid unnecessary additional examinations.

References

1. A Cuxart, J Iborra, M Melendez, E Pages (1992) Physeal injuries in myelomeningocele patients. Paraplegia 30 (1992) 791-794.

2. Joseph G Khoury, MD and Jose A Morcuende (2002) Dramatic Subperiosteal Bone Formation Following Physeal Injury in Patients with Myelomeningocele. Iowa Orthop J. 2002; 22: 94–98.

3. Mahmut Asirdizer , Yildiray Zeyfeoglu (2005) Femoral and tibial fractures in a child with myelomeningocele. Journal of Clinical Forensic Medicine 12 (2005) 93–97.

4. J.A.Roberts, G.C Bennet, J.R MacKenzie ;(1989) Physeal widening in children with myelomeningocele; The journal of bone and joint surgery 1989; 71-B: 30-32.