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Lower limb cast predicts bone loss after fracture in children

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Children who require cast immobilization for a leg or ankle fractures develop osteopenia in the affected limb, demonstrates research published in the Journal of Bone and Joint Surgery.

MedWire News: Children who require cast immobilization for a leg or ankle fractures develop osteopenia in the affected limb, demonstrates research published in the Journal of Bone and Joint Surgery.

"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," say Dimitri Ceroni and co-authors, from the University Hospitals of Geneva in Switzerland.

The team examined for changes in bone mineral density (BMD) in 50 patients aged 10-16 years who had sustained ankle (n=42), or tibia and fibula (n=8) fractures. The majority (n=32) of patients were treated with closed reduction and cast immobilization, while 18 patients had closed reduction and stabilization using percutaneous wires/screws plus a long leg cast.

At the time of fracture, patients did not significantly differ from age- and gender-matched healthy controls with regard to total body or lumbar spine BMD or bone mineral content, or calcaneus BMD.

However, when the casts were removed, there was a highly significant reduction in bone parameters on the injured side of the patient compared with the uninjured side. Specifically, the researchers detected a 5.8-31.7% decrease in BMD, and a 5.2-19.4% decrease in bone mineral content in the patients.

Furthermore, patients experienced a significant BMD decrease at the hip, trochanter, calcaneus, and total lower limb while wearing the cast, compared with the healthy controls.

For the calcaneal bone, the injured limb showed a significant reduction in median BMD compared with healthy controls, whereas the uninjured side showed no significant difference.

"As previously shown in adult populations, the decrement of bone mineral occurs not only at the level of the fracture but also at adjacent lower-limb sites both proximal and distal to the fracture," comment Ceroni et al.

"These results may encourage physicians, coaches, and physical education professionals to instruct adolescents who have sustained a lower-extremity fracture to delay their return to strenuous physical activities and competitive sports."

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