Flexible intramedullary nailing for supracondylar femoral fractures in children with Duchenne muscular dystrophy
Unusual or unexpected effect of treatment
Marco Distefano, Camilla Bettuzzi, Giada Salvatori, Giovanna Cristella, Caterina Novella Abati, Manuele Lampasi
Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Am J Case Rep 2020; 21:e924460
Available online: 2020-09-29
Femoral fractures are common in patients with Duchenne muscular dystrophy (DMD) and represent a critical moment in the natural history of the disease. The immobilization required for fracture healing frequently leads to further weakening and worsening (or definitive loss) of functional abilities. Surgical treatment has been advocated in ambulatory and nonambulatory patients with rapid mobilization of patients as the main goal; however, it exposes patients to considerable anesthetic risk.
CASE REPORT: We present a previously unreported experience of flexible intramedullary nailing (FIN) in 2 DMD patients (aged 11.7 and 12.8 years) who were still able to walk or stand when the supracondylar femoral fractures occurred. The surgical procedures were performed with sufficient reduction and stabilization of fractures. Rapid mobilization of the patients was achieved, including muscle strengthening exercises. A prompt recovery of the upright standing position and successive ambulation was accomplished in the patient with the higher functional status before the fracture, whereas the standing ability was not recovered in the other patient. No increase of knee flexion contractures and no growth disturbances were recorded at the follow-up.
CONCLUSIONS: The operative treatment option should be considered by a multidisciplinary team; they should evaluate the advantages and risks for each patient considering their functional status. For ambulatory children (or patients still able to stand), FIN can represent a valid, minimally invasive, apparently growth-sparing and sufficiently stable osteosynthesis, allowing rapid rehabilitation of the patient that can limit, but not completely avoid the consequences of the femoral fracture.
Keywords: Child, Femoral Fractures, Fracture Fixation, Intramedullary, Muscular Dystrophy, Duchenne