Abstract
Aim: There were no reports of epiphyseal separation in cerebral palsy/spastic conditions, though cases of displaced metaphyseal & diaphyseal fractures have been reported.
Materials and Methods: There were 9 cases of epiphyseal separation involving the distal femur and proximal humerus in 4 severely handicapped children with spastic cerebral palsy. In these 9 cases there was significant epiphyseal slip with periosteal stripping with extensive subperiosteal ossification obvious on the X-rays. The X-rays also showed the following radiological signs: Frankel’s line and a scurvy line. Clinically the area was swollen and painful.
Results: The X-ray appearances confirmed the cause to be that of scurvy. Treatment was with Vitamin C, Vitamin D, nutritional support and splintage which resulted in rapid healing with excellent re-modelling. Lack of Vitamin C results in suppression of osteoblasts and interferes with collagen synthesis.
Conclusion: Scurvy should be considered as a potential cause of an epiphyseal slip in a child suffering from severe cerebral palsy. Routine Vitamin C dietary supplementation in this group of potentially mal-nourished, non-ambulant children should be considered. The cause of the slip is thought to be lack of Vitamin C in combination with weakness of the bone, spastic muscle acting on long, fragile bones and in some cases, anti-convulsant treatment.
The abstracts were prepared by the Editorial Secretary Robin W Paton. Correspondence should be addressed to him c/o BOA, 35–43 Lincoln’s Inn Field, London WC2A 3PN.
