{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:50:40Z","timestamp":1777888240655,"version":"3.51.4"},"reference-count":12,"publisher":"SAGE Publications","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PRM"],"published-print":{"date-parts":[[2023,9,19]]},"abstract":"<jats:p>Proximal humerus fractures in pediatric patients are uncommon. This is a case report of a 17-year-old patient with Duchenne muscular dystrophy who sustained an occult proximal humerus fracture. The patient was on chronic steroids and had a history of vertebral and long bone fractures. He was using a wheeled mobility device on public transportation at the time of injury. He had a negative radiograph, but an MRI revealed a right proximal humerus fracture. He had decreased mobilization in the affected extremity, which limited activities of daily living including driving his power wheelchair. After six weeks of conservative management, he returned to his baseline level of activity. It is important to recognize that chronic steroid use adversely affects bone health, and fractures may be missed on initial imaging. To ensure adequate safety, providers, patients, and their families should be educated on the Americans with Disabilities Act guidelines for using wheeled mobility devices on public transportation.<\/jats:p>","DOI":"10.3233\/prm-220074","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T10:26:47Z","timestamp":1686652007000},"page":"571-574","source":"Crossref","is-referenced-by-count":0,"title":["Uncommon fracture in Duchenne muscular dystrophy: A case report"],"prefix":"10.1177","volume":"16","author":[{"given":"Lyndsey","family":"Booker","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaclyn","family":"Omura","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA"},{"name":"Seattle Children\u2019s Hospital, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"key":"10.3233\/PRM-220074_ref1","doi-asserted-by":"publisher","first-page":"928385","DOI":"10.1155\/2015\/928385","article-title":"Optimizing bone health in Duchenne muscular dystrophy","volume":"2015","author":"Buckner","year":"2015","journal-title":"Int J Endocrinol"},{"issue":"19","key":"10.3233\/PRM-220074_ref2","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1212\/01.wnl.0000260974.41514.83","article-title":"Orthopedic outcomes of long-term daily corticosteroid treatment in Duchenne muscular dystrophy","volume":"68","author":"King","year":"2007","journal-title":"Neurology"},{"issue":"Suppl 2","key":"10.3233\/PRM-220074_ref3","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1542\/peds.2018-0333E","article-title":"Bone health and osteoporosis management of the patient with Duchenne muscular dystrophy","volume":"142","author":"Ward","year":"2018","journal-title":"Pediatrics"},{"issue":"9","key":"10.3233\/PRM-220074_ref4","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1177\/0883073816650034","article-title":"Fracture in Duchenne Muscular Dystrophy: Natural History and Vitamin D Deficiency","volume":"31","author":"Perera","year":"2016","journal-title":"J Child Neurol"},{"issue":"10119","key":"10.3233\/PRM-220074_ref5","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/S0140-6736(17)32160-8","article-title":"Long-term effects of glucocorticoids on function, quality of life, and survival in patients with Duchenne muscular dystrophy: a prospective cohort study","volume":"919","author":"McDonald","year":"2018","journal-title":"Lancet"},{"key":"10.3233\/PRM-220074_ref6","unstructured":"Americans with Disabilities Act (ADA) accessibility specifications for transportation vehicles ADA, 49 CFR part 38. National Archives Code of Federal Registrations; 1990."},{"issue":"6","key":"10.3233\/PRM-220074_ref7","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1682\/jrrd.2011.06.0098","article-title":"Investigation of wheelchair instability during transport in large accessible transit vehicles","volume":"49","author":"Salipur","year":"2012","journal-title":"J Rehabil Res Dev"},{"issue":"2","key":"10.3233\/PRM-220074_ref8","doi-asserted-by":"publisher","first-page":"77","DOI":"10.5435\/JAAOS-D-14-00033","article-title":"Evaluation and management of pediatric proximal humerus fractures","volume":"23","author":"Popkin","year":"2015","journal-title":"J Am Acad Orthop Surg"},{"key":"10.3233\/PRM-220074_ref9","doi-asserted-by":"publisher","first-page":"370169","DOI":"10.1155\/2013\/370169","article-title":"Radiographically occult and subtle fractures: a pictorial review","volume":"2013","author":"Jarraya","year":"2013","journal-title":"Radiol Res Pract"},{"issue":"5","key":"10.3233\/PRM-220074_ref10","doi-asserted-by":"publisher","first-page":"e20190724","DOI":"10.1542\/peds.2019-0724","article-title":"Transporting Children With Special Health Care Needs","volume":"143","author":"O\u2019Neil","year":"2019","journal-title":"Pediatrics"},{"issue":"4","key":"10.3233\/PRM-220074_ref11","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/S1474-4422(18)30025-5","article-title":"Diagnosis and management of Duchenne muscular dystrophy, part respiratory, cardiac, bone health, and orthopaedic management","volume":"17","author":"Birnkrant","year":"2018","journal-title":"Lancet Neurol"},{"key":"10.3233\/PRM-220074_ref12","unstructured":"Pediatric Positions. 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