METAPHYSEAL AND PHYSEAL INJURIES IN CHILDREN WITH SPINA BIFIDA AND MENINGOMYELOCELES

¹ Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts
² Department of Radiology, Arkansas Children's Hospital, Little Rock, Arkansas

Bizarre skeletal changes are frequently seen in the lower extremities of children with spina bifida vera and meningomyeloceles who are not completely paralyzed. These changes are due to multiple small fractures and subsequent healing at the metaphyseo-physeal junctions in insensitive extremities, which are subjected to the chronic stress of weightbearing. There are a number of entities in which the underlying pathology is identical: repeated trauma—but the predisposing factors to trauma are multiple and varied. These different entities form a spectrum of metaphyseo-physeal injuries. The spectrum extends from the gross abnormalities of bedridden paraplegics, through severe changes in children with insensitivity to pain of differing etiology to the least pronounced metaphyseal changes in slipped capital femoral epiphysis.

It is hoped that the recognition of these skeletal changes and the understanding of their pathogenesis will prevent the needless surgery of open biopsy or aspiration for culture to which many of these children were subjected in the past.

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