The Journal of Bone and Joint Surgery, Vol 74, Issue 2 211-218, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Residual bone-mineral density and muscle strength after fractures of the tibia or femur in children
RC Henderson, GJ Kemp and ER Campion
University of North Carolina School of Medicine, Chapel Hill 27599-7055.
This study compared the bone-mineral density in the proximal part of the
femur and the flexion and extension strength of the knee in the fractured
and the non-fractured limbs after an uncomplicated fracture of the tibia or
femur in children. Thirty-eight children, whose ages ranged from two to
fifteen years at the time of the injury, were evaluated at an average of
2.3 years after the injury. The mean difference in bone-mineral density
between the fractured and non-fractured limbs was 3.3 per cent (p = 0.004).
There was no significant difference between the bone-mineral density of the
limbs that had been immobilized for less than four weeks and that of the
contralateral, non-fractured limbs. However, the mean difference between
the bone-mineral density of the limbs that had been immobilized for more
than eight weeks and that of the contralateral limbs was 4.3 per cent (p =
0.006). There was little or no relationship between the time since the
injury and the difference in bone-mineral density between the two limbs of
the patient at the intervals of follow-up that were studied. No residual
weakness in flexion and extension of the knee was detected, and no
relationship was established between the limb-to-limb differences in
strength and the limb-to-limb differences in bone-mineral density. The
residual bone-mineral deficit was found to be minimum after an
uncomplicated fracture. This difference, while statistically significant,
is unlikely to be clinically important in the long term. However, the fact
that there was a deficit raises a potential concern for children who have
more severe or repeated injuries.
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