Distefano Marco, Bettuzzi Camilla, Salvatori Giada, Cristella Giovanna, Abati Caterina Novella, Lampasi Manuele
Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Florence, Italy.
Am J Case Rep. 2020 Nov 11;21:e924460. doi: 10.12659/AJCR.924460.
BACKGROUND 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.
股骨骨折在杜氏肌营养不良症（DMD）患者中很常见，是该疾病自然史中的一个关键时刻。骨折愈合所需的固定常常导致功能能力进一步减弱和恶化（或最终丧失）。手术治疗已被提倡用于能行走和不能行走的患者，主要目标是使患者快速活动；然而，这会使患者面临相当大的麻醉风险。病例报告：我们介绍了2例DMD患者（年龄分别为11.7岁和12.8岁）的弹性髓内钉固定术（FIN）的既往未报道经验，这2例患者在股骨髁上骨折发生时仍能行走或站立。手术过程中对骨折进行了充分复位和固定。实现了患者的快速活动，包括肌肉强化锻炼。骨折前功能状态较好的患者迅速恢复了直立站立姿势并随后能够行走，而另一例患者的站立能力未恢复。随访时未记录到膝关节屈曲挛缩增加和生长障碍。结论：多学科团队应考虑手术治疗方案；他们应根据每个患者的功能状态评估其利弊。对于能行走的儿童（或仍能站立的患者），FIN可代表一种有效的、微创的、明显保留生长且足够稳定的骨固定方法，能使患者快速康复，可限制但不能完全避免股骨骨折的后果。
