Synovectomy of the knee in patients with hemophilia presenting in countries with demographic characteristics that make central referral difficult is the subject of this article. Ten patients, six surgeons, and two countries contributed to this study, which demonstrated that approximately 40% of these patients had no further hemarthroses into the affected joint and the remainder had reduced frequency and severity of bleeding. Continuous passive motion has an important place in postoperative management, and manipulation with the patient under anesthesia is of doubtful value. The possible relationship between diminished range of movement and a successful outcome in terms of abolition of hemorrhage is explored. One patient underwent synovectomy of the knee without complication; the other nine suffered significant complications.

Adolescent↗

PubMedDate not supplied

Hand function in patients with spina bifida cystica.

The Jebsen-Taylor hand function test was performed on 143 patients with myelomeningocele, 8-35 years of age. Compared with normal individuals, matched for sex and age, patients with myelomeningocele demonstrated impaired hand function. Thoracic level and high lumbar level patients exhibited poorer hand function than low lumbar and sacral level patients. Patients who required more than three shunt operations for continued control of hydrocephalus were more likely to have abnormal hand function. Awareness of such deficiencies should enable orthopedic surgeons, therapists, and parents to establish realistic functional expectations and management aims for these children.

Adolescent↗

PubMedDate not supplied

Efficacy of surgical management for scoliosis in myelomeningocele: correction of deformity and alteration of functional status.

The effect of spinal fusion for paralytic scoliosis in 49 patients with myelomeningocele was studied. Improved sitting balance was seen in 70% of the patients following anterior and posterior fusions, 67% following posterior fusion alone, and 28% after anterior fusion alone. The ability to ambulate was adversely affected in 67% of the patients who had undergone combined anterior and posterior fusions, in 57% following anterior fusion alone, and in 27% following posterior fusion alone. Sitting is likely to be improved but ambulation may be more difficult following spinal correction and fusion.

Child↗

PubMedDate not supplied

Natural history of flexion deformity of the hip in myelodysplasia.

For definition of the incidence and natural history of hip flexion contracture, 5,147 serial measurements of the range of hip extension in 966 patients with spina bifida were analyzed. Contractures were generally present in the first few months of life (physiologic flexion posture); this then diminished during the first 27 months in all but those with thoracic lesions. Hence, surgical management is seldom appropriate until after that age. In general, contractures reappear or worsen between the ages of 3 and 6 years, but few patients with sacral lesions develop this deformity. Our findings also demonstrate that hip flexion contracture is not merely due to muscle imbalance, sitting posture, or these factors in combination.

Adolescent↗

PubMedDate not supplied

Subsidiary lateral femoral condyle in arthrogryposis multiplex congenita.

A previously undescribed anomaly of the distal femur occurred in a 3-month-old child with arthrogryposis multiplex congenita. There was a large boss of bone superior and posterior to the true lateral femoral condyle with which the lateral tibial femoral condyle articulated. To obtain full extension of the knee, it was necessary to perform a full posterior release and to replace the tibial condyle distally onto the true lateral condyle. The etiology of the anomaly remains conjectural, but the lesion should be sought for in patients with resistant flexion contracture requiring surgical release.

Arthrogryposis↗

PubMedDate not supplied

Significance of the strength of the quadriceps muscles in children with myelomeningocele.

A study of 109 patients with myelomeningocele indicates that useful assessment of quadriceps power can be made during the first 3 years of life. In 21 of 22 patients assessed in those years as having grade 4 quadriceps power, an increase in power was observed in ensuing years, but no such trend was observed in patients with less quadriceps power. Only four of 51 patients who were initially assessed as having quadriceps power of grade 5 showed deterioration in this muscle power over the ensuing years. Ambulatory ability was closely related to quadriceps muscle power.

Adolescent↗

PubMedDate not supplied

Treatment of spastic equinus by aponeurosis lengthening.

The aponeurosis lengthening described in this study was performed on 156 patients (219 procedures) with spastic equinus deformities. There was only one wound complication and no calcaneus deformities from overlengthening. The recurrence rate requiring relengthening was high (48% of the procedures), particularly if the initial operation was performed before the age of 5 years. The length of postoperative immobilization did not affect the recurrence rate. The aponeurosis lengthening technique described is a simple lengthening of the aponeurosis, leaving the soleus largely intact without the use of internal sutures. It has a negligible complication rate, but a high rate of recurrent equinus.

Age Factors↗

PubMedDate not supplied

Avascular necrosis after open reduction for congenital dislocation of the hip: analysis of causative factors and natural history.

We analysed the causative factors and natural history of avascular necrosis (AVN) after open reduction of 87 dislocated hips. AVN was observed in 37% of the hips, yet open reduction did not appear to contribute to the development of AVN and its prevalence was similar in hips treated by open or closed reduction in our institution. Only 45% of hips with AVN had a good late result. More containment procedures were required if AVN had occurred. Premature physeal closure was one late manifestation of this complication, which occurred following apparent partial AVN changes.

Acetabulum↗

PubMedDate not supplied

Three additional cases of focal fibrocartilaginous dysplasia causing tibia vara.

Three additional cases of unilateral tibia vara caused by focal fibrocartilaginous dysplasia are reported in children aged 5, 6, and 18 months. These three cases support the conclusion of our original case report that unilateral tibia vara is most likely a progressive deformity, but that documentation of the progression should be obtained before a valgus osteotomy is performed.

Female↗

PubMedDate not supplied

Osteochondritis of the first metatarsal epiphysis.

Two cases of painful osteochondritis of the basal epiphysis of the first metatarsal are described. Complete resolution without deformity was achieved in both patients. We suggest that this condition be considered in the differential diagnosis of transitory foot pain in childhood.

Adolescent↗

PubMedDate not supplied

Association of slipped upper femoral epiphysis and peroneal spastic flatfoot.

A significant association between slipped upper femoral epiphysis (SCFE) and subtalar arthritis causes peroneal spastic flatfoot. Three patients with this association were observed in 136 cases of SCFE, an incidence of 2.3%; the anticipated incidence would be 0.4%. We postulate that both conditions reflect an underlying immunologic disorder.

Adolescent↗

PubMedDate not supplied

Natural history of knee contractures in myelomeningocele.

The natural history of knee contracture was determined in a prospective study of 850 myelomeningocele (MM) patients, ranging in age from neonate to 23 years, excluding patients after knee surgery. Fixed flexion contracture of 10 degrees at birth decreased by age 9 months but increased thereafter if the patient's MM level was higher than L3. In the thoracic/L1-L3 level patients, the mean fixed flexion contracture was 18 degrees with and 17 degrees without knee flexor spasticity. Range of knee flexion remained at 126 degrees until age 3 years, and decreased thereafter if the patient's MM was higher that L3. This study demonstrates that muscle imbalance and spasticity play a minimal role in development of knee contracture.

Adolescent↗