Patient with multiple sclerosis diagnosis after fibula fracture: Holistic view of a rehabilitation patient

Patient with multiple sclerosis diagnosis after fibula fracture: Holistic view of a rehabilitation patient

Multiple sclerosis (MS) is a disease with chronic progressive neurological symptoms. Multiple sclerosis patients are frequentlyobserved to have balance problems and falls, and these may occur as initial symptoms. Distal fibula fractures comprise a significantproportion of ankle fractures occurring commonly after trauma or falls. This report presents the case of a 49-year old female patientdeveloping right distal fibula fracture after a fall 4 years previously, who attended the rehabilitation clinic many times due to inabilityto walk in spite of full union of the bone. Detailed anamnesis included frequent falls and loss of balance before the fracture. Thepatient had upper motor neuron findings identified, and in light of the clinical findings along with cranial MR images, the patient wasdiagnosed with primary progressive multiple sclerosis. Attending rehabilitation after fractures at young-middle age, patients shouldbe questioned carefully about the loss of balance and history of falling, and detailed neurological examination should definitely beperformed in addition to an orthopedic examination.

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  • 1. Hasselman CT, Vogt MT, Stone KL, et al. Foot and ankle fractures in elderly White women. Incidence and risk factors. J Bone Joint Surg Am 2003;85:820-4.
  • 2. Makwana NK, Bhowal B, Harper WM, et al. Conservative versuso perative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br 2001;83:525-9.
  • 3. National Multiple Sclerosis Society. Epidemiology of multiple sclerosis. Available at: http://www.nmss.org. access date 12 02.2007.
  • 4. Miller DH, Leary SM. Primary-progressive multiple sclerosis Lancet Neurol 2007;6:903-12
  • 5. Tinetti ME, Doucette J, Claus E, et al. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995;43:1214-21.
  • 6. Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol 1991;46:164-70.
  • 7. Cattaneo D, De Nuzzo C, Fascia T, et al. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 2002;83:864-7.
  • 8. Cosman F, Nieves J, Komar L, et al. Fracture history and bone loss in patients with MS. Neurology 1998;51:1161-5.
  • 9. Alexander BH, Rivara FP, Wolf ME. The Cost and Frequency of Hospitalization for Related Injuries in Older Adults. Am J Public Health 1992;82:1020-23.
  • 10. Lamb SE, Jorstad Stein EC, Hauer K, et al. Prevention of falls network europe and Outcomes consensus group. development of a common outcome Data set for fall Injury preventation trials: the preventatidn of falls network europe consensus. J Am Geriatr Soc 2005;53:1618-22.
  • 11. Williams, Katrina. Balance for people with multiple sclerosis (MS). In Phu Hoang, Robyn Smith and Kathy Hutton Edition, MS practice for health professionals. Lidcombe, Australia; 2009. pp. 1-14
  • 12. Dong G, Zhang N, Wu Z, et al. Multiple sclerosis increases fracture risk: a meta-analysis. Biomed Res Int. 2015;2015:650138.
  • 13. Su S, Liu H. The association between multiple sclerosis and fracture risk. Int J Clin Exp Med 2014;7:4327-31.
  • 14. Martin CL, Phillips BA, Kilpatrick TJ, et al. Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler 2006;12:620-8.
  • 15. Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 with MS. Arch Phys Med Rehabil 2006;87:1274-9.
Annals of Medical Research-Cover
  • Yayın Aralığı: Aylık
  • Yayıncı: İnönü Üniversitesi Tıp Fakültesi