P.7.12 Recovery of ambulation and functional mobility in boys with Duchenne Muscular Dystrophy following femoral fractures

Abstract

Boys with Duchenne Muscular Dystrophy (DMD) have been found to have decreased bone density and increased risk of fractures. Lower extremity (LE) post-fracture recovery often includes prolonged periods of non/partial weight bearing with increased amounts of time spent sitting in wheelchairs, increasing the risk of contractures and disuse weakness. Reported incidence of loss of independent ambulation following LE fractures varies from 20 to 50%. A retrospective chart review of the medical records of 7 ambulatory boys with DMD who sustained femur fractures over the past 5years and for whom early post-fracture rehabilitation was recommended was completed to determine average age at fracture, and functional motor skills pre/post fracture. Boys ranged from 9 to 15years of age at the time of fracture and were all independent ambulators. Their pre-fracture timed 30ft. run averaged 6.5s (3.8–9.7). The majority of fractures were managed surgically but one, a distal femur fracture, was casted without surgical intervention. Physical therapy, typically including hip/knee flexor and ankle plantar flexor stretches, active exercise, and early weight bearing on the uninvolved and, as soon as possible, on the involved leg, was recommended during the period of fracture healing. All 7 boys regained independent ambulation after their fractures, although one continued to use a walker. Time function tests were available for 5 of 7 boys after their initial recovery with an average 30ft. run time of 7.5s (5.0–11.7). One boy required a walker to ambulate, while another was unable to complete timed testing. Only one boy had both pre and post-fracture North Star Ambulatory Assessment scores available and these were 16/34 pre-fracture and 14/34 post-fracture. Results suggest that with a protocol of early mobilization, active exercise, and stretching, ambulation and functional mobility may be maintained following femoral fractures.