Rajani Amyn M, Rajani Kareena, Mittal Anmol Rs, Shah Urvil A, Rajani Khushi A, Rajani Kashish A
Department of Orthopaedics, OAKS Clinic, Mumbai, Maharashtra, India.
Department of Clinical Research, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2022 Aug;12(8):93-97. doi: 10.13107/jocr.2022.v12.i08.2980.
Pathological fractures in pediatric age group are most commonly secondary to bone tumors. Management of such cases in patients with autism spectrum disorder (ASD) is complicated by the prevalence of low bone mineral density (BMD) in these patients.
Through this case, we report a 13-year-old male diagnosed with autism spectrum disease, who was brought by his parents with a history of trivial trauma and gross deformity of the left humerus. On plain radiography, a displaced fracture in the foreground of a lytic, cystic lesion was noted which on magnetic resonance imaging was confirmed to be metadiaphyseal unicameral bone cyst. The patient underwent extensive curettage, allograft impaction, and definitive fixation by a locking compression plate. Following a relatively extended period of immobilization, he was started on range of motion exercises followed by strengthening. He was able to return to his pre-operative activity levels at 14 weeks postoperatively. At 1-year postoperatively, the patient achieved excellent clinical and radiological outcomes, without any signs of failure, complications, or signs of recurrence.
Management of pathological fractures in pediatric patients with ASD can be challenging due to the associated low BMD and potential non-compliance from the patient's end. Such cases are best treated with open curettage, allograft impaction, and definitive fixation by locking compression plate, even if present in a non-weight bearing bone.
儿童期病理性骨折最常见的继发于骨肿瘤。自闭症谱系障碍(ASD)患者中此类病例的管理因这些患者普遍存在低骨密度(BMD)而变得复杂。
通过本病例,我们报告一名13岁男性被诊断为自闭症谱系疾病,其父母带他前来就诊,有轻微外伤史及左肱骨严重畸形。X线平片显示在一个溶骨性囊性病变前方有移位骨折,磁共振成像证实为干骺端单房性骨囊肿。患者接受了广泛刮除、异体骨嵌压,并采用锁定加压钢板进行确定性固定。经过相对较长时间的固定后,开始进行关节活动度练习,随后进行强化训练。术后14周他能够恢复到术前的活动水平。术后1年,患者取得了优异的临床和影像学结果,没有任何失败、并发症或复发迹象。
由于ASD患儿存在低骨密度且患者可能不配合,其病理性骨折的管理具有挑战性。即使骨折发生在非负重骨,此类病例最好采用开放刮除、异体骨嵌压及锁定加压钢板确定性固定进行治疗。