PubMed · 6677984
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O Avanzi, W de Carvalho Pinto Filho. [Vertebral deformities].. https://pubmed.ncbi.nlm.nih.gov/6677984/
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INTRODUCTION: An increasing number of infants presenting with posterior cranial asymmetry are referred to the paediatric neurosurgeon for clinical evaluation. Most of these cranial dysmorphisms cannot be due to lambdoidal sinostosis, since they originate from pre- (intrauterine constraint) or postnatal (prematurity, torticollis, sleeping position) predisposing factors that have deformed the cranial vault. In the literature there is broad consensus about the conservative management of this nonsynostotic plagiocephaly by means of "positional therapy" or "orthoplasty moulding" with cranial helmets or bands. Some reports can be found about the effectiveness of so-called dynamic orthotic cranioplasty (DOC) to improve the cranial asymmetry. TECHNICAL NOTE: In order to simplify the manufacturing procedure and improve the modulation of the corrective forces, we have designed a new orthotic device (thermoplastic orthotic device, TOD) using thermoplastic materials that can be moulded directly on the infant's head. CONCLUSION: With this technique it is no longer necessary to take any cranial impressions and the orthotic device can be easily remodelled, ensuring perfect adaptability of the device to the cranial vault throughout the entire treatment. Moreover, the superior flexibility of this orthosis allows modulation of the corrective forces.
AIM: The aim of our investigations was to answer the question of whether the radiologic classification according to the investigations of Nasca has prognostic relevance for congenital scoliosis. Based on our results, a therapeutic concept was given. PATIENTS AND METHODS: Radiographs of 49 patients with a congenital scoliosis were classified according to Nasca. The progression of the malformation was analyzed by regarding the changes over a period of 8.3 years on average. RESULTS: Of the analyzed patients with congenital scoliosis, 73% showed a mean progression rate of 1.8 degrees per year. The most advanced progress of the Cobb angle per year was seen in patients with unilateral unsegmented bars with or without additional hemivertebrae (type 4 according to the Nasca classification) and patients with wedge-formed vertebrae (type 2a according to the Nasca classification). The presence of unilateral bars and the location of the hemivertebra or hemivertebrae (type 4) and wedge-formed vertebrae (type 2a) are the major determinants of deformity. Within the scope of our investigations, the following three factors were seen as deleterious when combined: thoracolumbal and long-distance scoliosis, female gender, and prepubertal growth period. CONCLUSION: From our analysis of 49 patients, we can propose the following therapeutic system for congenital scoliosis. Sole treatment with physiotherapy should only be recommended with congenital scoliosis curves ranging from 0 degrees to 20 degrees according to the Cobb method. With a Cobb angle smaller than 40 degrees and some flexibility remaining in the spine, the congenital scoliosis should be treated additionally with corrective casts. For congenital scoliosis with a Cobb angle of more than 50 degrees, as well as for congenital scoliosis with a poor prognosis (for example unilateral bars), a spondylodesis of the spine should be done before reaching the age of 5 years.
A 4-month-old Japanese girl with a developmental dislocation of the right hip was treated with manual reduction under general anesthesia followed by cast immobilization. Serial magnetic resonance imaging (MRI) revealed that a large interposition of fat tissue in the acetabulum, observed immediately after cast immobilization, became remarkably small in size as the congruity improved after 3 weeks. These MRI findings demonstrate the mechanism of a "squeezing phenomenon" after reduction of the hip.