• Sulenur Yildiz, Allan M Glanzman, Tim Estilow, Jean Flickinger, John F Brandsema, Gihan Tennekoon, Brenda L Banwell, and Sabrina Yum.
• From the Department of Physical Therapy and Rehabilitation, Hacettepe University,Faculty of Health Sciences, Ankara, Turkey (S. Yildiz); Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (AMG, JF); Department of Occupational Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (TE); Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (JFB, GT, BLB, S. Yum); and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (JFB, GT, BLB, S. Yum).
• Am J Phys Med Rehabil. 2020 Sep 1; 99 (9): 789-794.

ObjectivePrevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated.DesignChart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture.ResultsTwo hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side, P = 0.021), quadriceps strength (right side, P = 0.025), and shoulder abduction strength (right, left, and fracture side; P = 0.028, P = 0.027, and P = 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.25 vs. -7.29, P = 0.004; 2.67 vs. -12, P = 0.001; and 2.41 vs. -7.42, P = 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs, P = 0.005).ConclusionsFracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture.To Claim Cme CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy.LevelAdvanced.AccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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