Fractures^(10-12)

Patients with Duchenne are more liable to suffer from fractures for a number of reasons:

• Less mobile and fall more frequently.
• Decreased bone density even in steroid naive patients.
• Steroid treatment reduces bone mineral density.

In Hospital

Ambulant patients should ideally be treated with internal fixation which aids early mobilisation. However, careful consideration should be taken regarding anaesthetic risk (see anaesthesia section). Othotic advice should be sought before immobilisation. The safest and fastest way to promote healing should be adopted.

Early contact with physiotherapy is essential to encourage continued ambulation. Periods of immobility can lead to permanent loss of ambulation.

In non-ambulant patients, requirement for internal fixation is not as acute and therefore splinting or casting of a fracture is appropriate.

• Casting should be in a good functional position.

Vertebral fractures should be treated with IV bisphosphonates in conjunction with advice from a bone specialist/endocrinologist.

In either case, if breathing rapidly and/or neurologic deterioration is in evidence (i.e. confusion) after a fracture or body trauma, then investigate possible fat embolism syndrome.

After Care

If not on bone protection - consider referral to endocrinologist for preventative treatment - especially if on chronic steroids.