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Effects of Cast-Mediated Immobilization on Bone Mineral Mass at Various Sites in Adolescents with Lower-Extremity Fracture

Ceroni, Dimitri MD; Martin, Xavier MS PhysEd; Delhumeau, Cécile PhD; Rizzoli, René MD; Kaelin, André PD; Farpour-Lambert, Nathalie MD

Journal of Bone & Joint Surgery - American Volume: 1 February 2012 - Volume 94 - Issue 3 - p 208–216
doi: 10.2106/JBJS.K.00420
Scientific Articles
Supplementary Content

Background: Leg or ankle fractures occur commonly in the pediatric population and are primarily treated with closed reduction and cast immobilization. The most predictable consequences of immobilization and subsequent weight-bearing restriction are loss of bone mineral mass, substantial muscle atrophy, and functional limitations. The purposes of this study were to determine if lower-limb fractures in adolescents are associated with abnormal bone mineral density or content at the time of fracture, and to quantify bone mineral loss at various sites due to cast-mediated immobilization and limited weight-bearing.

Methods: We recruited fifty adolescents aged ten to sixteen years who had undergone cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of the total body, lumbar spine, hip, leg, and calcaneus were performed at the time of fracture and at cast removal. Patients with a fracture were paired with healthy controls according to sex and age. Values at baseline and at cast removal, or at equivalent time intervals in the control group, were compared between groups and between the injured and uninjured legs of the adolescents with the fracture.

Results: At the time of fracture, there were no observed differences in the bone mineral density or bone mineral content Z-scores of the total body or the lumbar spine, or in the bone mineral density Z-scores of the calcaneus, between the injured and healthy subjects. At cast removal, bone mineral parameters on the injured side were significantly lower than those on the uninjured side in the injured group. Differences ranged from −5.8% to −31.7% for bone mineral density and from −5.2% to −19.4% for bone mineral content. During the cast period, the injured adolescents had a significant decrease of bone mineral density at the hip, greater trochanter, calcaneus, and total lower limb as compared with the healthy controls.

Conclusions: Lower-limb fractures are not related to osteopenia in adolescents at the time of fracture. However, osteopenia does develop in the injured limb during cast immobilization for fracture treatment. Further investigation is required to determine if the bone mineral mass will return to normal or if a permanent decrease is to be expected, which may constitute a hypothetical risk of sustaining a second fracture.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Service of Pediatric Orthopedics, Department of Child and Adolescent, University Hospitals of Geneva, 6, rue Willy Donzé, 1211 Geneva 14, Switzerland. E-mail address for D. Ceroni: dimitri.ceroni@hcuge.ch. E-mail address for X. Martin: xavier.martin@hcuge.ch. E-mail address for A. Kaelin: andre.kaelin@hcuge.ch

2Pediatric Research Platform, Department of Child and Adolescent, University Hospitals of Geneva, 6, rue Willy Donzé, 1211 Geneva 14, Switzerland. E-mail address: cecile.delhumeau@hcuge.ch

3Department of Rehabilitation and Geriatrics Service of Bone Diseases, University Hospitals of Geneva, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail address: rene.rizzoli@hcuge.ch

4Exercise Medicine, Pediatric Cardiology Unit, Department of Child and Adolescent, University Hospitals of Geneva, 6, rue Willy Donzé, 1211 Geneva 14, Switzerland. E-mail address: nathalie.farpourlambert@hcuge.ch

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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