Eighteen Fractures in a Man With Profound Mental Retardation

Abstract

A 39-year-old man with generalized tonic clonic epilepsy and profound mental retardation sustained 18 fractures (15 in appendicular and 3 in axial bones) during 19 years. Both femoral necks were fractured, requiring surgical repair. Although he had been on antiepileptic drugs for 35 years, he had no radiographic or biochemical sign of osteomalacia. He had a very low bone mineral density, suggesting osteoporosis. This case illustrates an important medical problem affecting people with developmental disability and a management challenge for their caretakers.

Health hazard evaluation report: HETA #2002-0218-2881, Jergens Road Adult Services Center, Dayton, Ohio.

“…16 Factors affecting bloodborne pathogen transmission include the amount of infected fluid, source infectivity, recipient susceptibility, and the site, duration, and dose of exposure. 17 Potential exposures of staff in residential developmental centers have been reported to occur primarily from residents' bites, fingernail scratches, and body fluids, and injury occurring occasionally from sharp instruments. Residents' bites also pose a potential risk of infection to the resident from the staff person who is bitten.…”

“…Residents' bites also pose a potential risk of infection to the resident from the staff person who is bitten. 17 The risk of bloodborne pathogen transmission from fingernail scratches has been reported to be minimal because the potential for enough infectious particles to be in dried blood under the nails is believed to be low. 17 The Centers for Disease Control and Prevention (CDC) estimates that 4 percent of HBV cases are acquired from occupational exposures and recommends pre-exposure vaccination of people at high risk of infection.…”

“…17 The risk of bloodborne pathogen transmission from fingernail scratches has been reported to be minimal because the potential for enough infectious particles to be in dried blood under the nails is believed to be low. 17 The Centers for Disease Control and Prevention (CDC) estimates that 4 percent of HBV cases are acquired from occupational exposures and recommends pre-exposure vaccination of people at high risk of infection. 18 The CDC recommended that "staff of nonresidential day-care programs (e.g., schools, sheltered workshops for the developmentally disabled) attended by known HBV carriers have a risk of HBV infection comparable to that among healthcare workers and therefore, should be vaccinated."…”

“…HIV only rarely exists in the saliva of infected persons, and when present exists at low levels. 27,28 Although the risk of HIV transmission from a bite appears to be negligible, 17,29 any employee (even those who are vaccinated against HBV) experiencing potential transmission of a bloodborne pathogen should be assessed immediately by an occupational health professional. For all bloodborne pathogens, avoiding exposures through the use of standard precautions is the recommended way to prevent occupational infection.…”

Besondere Bedeutung von Knochenstoffwechselstörungen bei mehrfach–behinderten Menschen mit Epilepsie

“…Ein Fallbericht eines 39-jährigen Mannes mit generalisierten tonisch-klonischen Anfällen und mittelgradiger Intelligenzminderung[15] beleuchtet das Problem der Knochenstoffwechselstörung bei mehrfachbehinderten Menschen mit Epilepsie (MmE). Dieser Patient erlitt insgesamt 18 Frakturen, davon 15 in flachen Knochen, 3 in langen Röhrenknochen innerhalb 19 Jahren.…”