Flexion contracture, internal rotation and external rotation of the hip were reported in 40 infants at 6 weeks and 3 months and in an independent sample of 40 infants at 6 months of age. Population means and normal ranges of motion were determined for use in the evaluation of hip problems and their treatment. A mean hip flexion contracture of 19 degrees was present at 6 weeks of age, decreasing to 7 degrees by three months, but still persisting at 6 months suggesting that forceful extension of the hip in infants may be contraindicated. Hip flexion contracture decreased in every child from 6 weeks to three months. In all cases, external rotation was greater than internal rotation. Internal rotation greater than external rotation before the age of 6 months appears contrary to normal development. There was a significant correlation between the changes in hip flexion contracture and internal rotation from 6 weeks to 3 months. An interesting extension of this study would be a longitudinal follow-up of infants beyond 6 months of age to further define these developmental trends.

Aging↗

PubMedDate not supplied

Slipped capital femoral epiphysis: case 3.

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Adolescent↗

PubMedDate not supplied

Coxa magna following surgical treatment of congenital hip dislocation.

We studied coxa magna after operative treatment of congenital dislocation of the hip, including incidence, relationship to treatment, and influence of coxa magna on the acetabulum. Coxa magna was defined as a femoral head with a horizontal diameter at least 15% greater than the symmetrical position on the opposite side. Coxa magna developed in 16 hips (33%). The mean increase was 20.9% (range 15-30%). Three factors correlated with coxa magna: femoral osteotomy (100%), open reduction (75%), and operation at a younger age (mean 15.6 vs. 35.8 months). Four of the 16 hips developed coxa magna following Type 1 avascular necrosis; no other growth deformities appeared. At follow-up, the acetabular indices and the center edge angles were not statistically different between the coxa magna and the control groups. One must avoid confusing coxa magna with hip subluxation or inadequate reduction, of which the latter requires appropriate treatment. Coxa magna gives a good hip if a concentric, congruous reduction is obtained, providing the acetabulum has enough growth potential for remodeling.

Child↗

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Segmental instrumentation without fusion in children with progressive scoliosis.

Nine young children had segmental spinal stabilization without fusion for progressive scoliosis. External bracing was not used. There were no immediate complications, but at a mean follow-up of 28 months, the mean loss of correction was 32% and only four patients maintained the initial correction. The mean interval spinal growth was only 0.8 cm. Rods failed in three patients, requiring revision and fusion. Thus, the early results of this technique are discouraging.

Braces↗

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Electromyography of idiopathic toe walking.

Eighteen idiopathic toe walkers were evaluated by gait electromyography to define muscle timing abnormalities. This group was compared with a matched group of normal children walking on their toes and to a group of patients with cerebral palsy and equinus deformities. Although timing in all three groups differed from normal timing, the two patient groups showed some statistically significant differences in phasic timing from the control group. However, no significant differences existed between toe walking and spastic children. Historical data (family history, male predominance, and learning disabilities) suggest that idiopathic toe walking is a true entity, although the gait electromyograms were not diagnostic.

Adolescent↗

PubMedDate not supplied

Role of radionuclide imaging in the diagnosis of acute osteomyelitis.

Over the last decade, the role of nuclear medicine studies in the diagnosis of acute osteomyelitis has been discussed in depth in the literature. Yet, the respective roles played in this setting by each of the commonly used radionuclide studies often are confusing. In an attempt to develop a cogent diagnostic strategy, we reviewed the literature published within the last 12 years pertaining to the use of radiophosphate bone scintigraphy as well as gallium and indium WBC imaging in the diagnosis of this condition. Based on our findings, we propose an alternative approach to the evaluation of a patient with suspected acute osteomyelitis.

Acute Disease↗

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Complications of intramedullary rods in osteogenesis imperfecta: Bailey-Dubow rods versus nonelongating rods.

Twenty-nine patients with osteogenesis imperfecta underwent 108 intramedullary roddings with 42 Bailey-Dubow rods and 66 nonelongating rods. The average age at insertion of the first rod was 5 years; average follow-up was 3.1 years (range 1-9 years). The overall complication rate was 60%-69% for Bailey-Dubow rods and 55% for nonelongating rods. Forty-seven percent of bones receiving rods required reoperation. Nonelongating rods had a 29% reoperation rate and a 24% replacement rate; Bailey-Dubow rods had a 19% reoperation rate and a 12% replacement rate.

Adolescent↗

PubMedDate not supplied

Cerebral palsy hip deformities: is there a consensus? II. Botulinum toxin A: a clinical experiment.

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Adolescent↗

PubMedDate not supplied

Functional versus organic knee pain in adolescents. A pilot study.

Psychologic factors, usually assessed with the Minnesota Multiphasic Personality Inventory, have been reported by various researchers as significant in certain groups of adult orthopaedic patients--most notably those with low back pain. Much less is known about children and adolescents or other orthopaedic complaints. We did a pilot study to determine how significant nonorganic factors are in adolescents presenting with knee pain and whether a brief screening protocol conducted in the waiting room can predict which adolescents do not have organic etiology for the knee pain. Twenty-eight consecutive adolescents were given the Junior-Senior High School Personality Questionnaire (HSPQ), and information on other variables was obtained prior to their first orthopaedic visit. Followup after six to eight months revealed that over a third of the patients had significant or predominant psychologic factors associated with the knee pain. The HSPQ and other individual variables were found, overall, to be of little help in differentiating between the functional and organic groups.

Adolescent↗

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Forefoot problems in cerebral palsy-diagnosis and management.

Forefoot deformities in cerebral palsy include cavus, metatarsus adductus, hallux valgus and bunion, dorsal bunion, and toe flexion contractures. Both prevention and correction of these deformities are surgical. Some can be prevented by lengthening or tenotomy of the spastic muscle that causes the dynamic deformity which eventually becomes the fixed skeletal deformity. Fixed deformities need osteotomies and arthrodesis of the bones in addition to removing the force of the deforming muscle. Some forefoot problems are related to the mid and hind foot, e.g., hallux valgus due to spastic pes valgus. Severe cavus can develop after overzealous Achilles tendon lengthening and failure to separate forefoot from hindfoot equinus.

Arthrodesis↗

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Sit-up exercises: an electromyographic study.

The effect of 5 different sit-up regimens on the abdominal muscle activity were investigated by electromyography as well as the degree of lumbar flexion required with each type of sit-up. In the long-lying position the rectus abdominus muscles were only active an average of 34% of the sit-up cycle. The greatest duration of activity (90%) was found in the shoulder lift hook-lying (knees flexed) sit-up in which the subject elevates the trunk to the point where the scapula is lifted from the mat. In addition, this sit-up requires minimal flexion of the lumbar spine (3 degrees versus 38 degrees) and is less likely to result in increased forces across the lumbar disk. The evidence is that this sit-up is the most effective in terms of abdominal muscle activity and the safest in terms of causing lumbar spinal flexion.

Abdominal Muscles↗

PubMedDate not supplied

Simple method of documenting metatarsus adductus.

A simple, accurate, and inexpensive method of documenting metatarsus adductus involves taking photocopies of the foot in the weightbearing position. Subsequently, treatment progress can be assessed objectively by reviewing serial photocopies. Some caution is urged because the strength of the glass copying surface of photocopying machines is unknown.

Copying Processes↗