Management of Femur Refractures in a 3-Year-Old Female with Myelomeningocele. A Case Report and Review of Literature

Abstract

Pathological Fractures (PF) affecting lower limbs have a prevalence ranging from 9% to 20% in children with myelomeningocele (MMC) [1]. It has been supported that the level of the injury involved has a great importance. On the one hand, the upper the level of the injury, the higher the risk of fracture, so thoracic-level injuries have 6 times higher risk of bone fracture, when comparing with sacral-level injuries [1]. On the other hand, Lock and Aronson [2] support that the localization of thoracic-level injuries usually involves femur fractures, while lumbar-level injuries mostly involve tibia fractures [2]; while Aliatakis et al.[3] find in their retrospective study of 210 patients that age at fracture has a stronger correlation with the fracture site than the level of the injury, being the fracture of the femur the most frequent one in the first five years of age and tibia and foot fractures after this age [3]. These fractures can affect different parts of the bone: metaphysis, diaphysis, or physis. It has been described different details in mechanism of injury, clinical presentation, treatment, and possible complications, depending on the affected site of the bone fracture.It is well known that after Spinal Cord Injury (SCI), it occurs pathological changes in bones and muscles below the neurological level of injury, such as a bone demineralization, muscle atrophy and increased adiposity, that lead to suffer osteopenia and osteoporosis, and therefore it increases the risk of bone fracture [4]. In metaphyseal and diaphyseal fractures, it can rarely,