Abstract
Over the five years 1997 and 2001 we evaluated five children (age range 10 to 14 years) with pathological femoral fractures due to rickets. All had quadriplegic cerebral palsy, and all were at home rather than in institutions. Four had been on long-term anticonvulsant therapy (ACT).
Radiographs showed typical features of rickets, with osteopoenia, cupping of metaphyses and widened growth plates. Biochemical analysis showed mean serum calcium of 1.87 mmol/l (1.71 to 2.2 – the normal range is 2.05 to 2.64), mean serum phosphate of 0.6 mmol/l (0.3 to 0.98 – the normal range is 1.0 to 1.85), and mean alkaline phosphatase of 1272 IU/l (414 to 2135 – normally less than 360).
The fractures were treated with Thomas splint traction or spica immobilisation. The rickets was treated with daily vitamin D (4000 IU) and calcium (1000 mg) for 3 months. The rickets healed radiologically at 2 months and the fractures united at 3 months.
For long-term prophylaxis a multifactorial therapeutic approach was adopted, entailing increasing exposure to sunlight, increasing dairy product intake, and changing the ACT to sodium valproate, which is less enzyme-inducing. No vitamin D supplementation was given.
At a mean follow-up of 3 years (2 to 8) no further fractures had occurred, and radiology and biochemistry were normal.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
