EFFECT OF HEMIPLEGIA ON SKELETAL MATURATION

Children with cerebral palsy have been reported to have poor growth an d delayed skeletal maturation, but it is unclear whether these effects are related to the underlying brain injury or to concomitant malnutri tion. This study was designed to evaluate the effects of hemiplegic ce rebral palsy on skeletal maturation and growth, with the unaffected si de used as each subject's control. Bilateral hand-wrist radiographs we re obtained for 19 children with spastic hemiplegia. Skeletal maturati on was determined in a blinded fashion with the Fels method. The skele tal age of the affected (hemiplegic) side was less than that of the un affected (control) side in all 19 subjects; the mean difference in ske letal age was 7.3 months (p <0.001). The delay in skeletal maturation of the affected side correlated linearly with age and upper extremity function. These findings show that brain injury results in delayed ske letal maturation independent of malnutrition. This effect on skeletal maturation may explain, in part, the reason that some children with ce rebral palsy grow poorly.