Physiotherapy-related impacted proximal tibia metaphyseal fracture in a child with myelomeningocele

Abstract

Pediatric cases with myelomeningocele are susceptible to fractures of lower extremities. Impacted proximal tibial metaphyseal fractures are uncommon injuries in pediatric age and peak around 3–6 years of age. Impacted fracture in proximal tibia region consists of periosteal buckling associated with compression load, particularly in metaphyseal area. Proximal tibial is an uncommon site for impacted fractures and the injury pattern in a child with paraplegia associated with myelomeningocele has been a rare report. As the displacement of the fracture is main concern, so a good splinting is the mainstay of treatment. Our report depicts a rare site of fracture in this subset of patients as well as treatment consideration in the form of short-term, light weight and fabricated bracing as the splints. Periodic supervised assessment for recurrence or de novo comorbidities as well as proper nutrition and therapy for osteomalacia is instrumental as part of the holistic management of such cases.