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

Experience with 1201 cerebrospinal fluid shunt procedures.

This report of our experience with 1,201 cerebrospinal fluid shunt procedures over a 17-year period includes two time periods: from 1965 to 1974 and from 1975 to 1982. The overall operative infection rate fell from 10.7% in the former period to 3.6% in the latter period. The overall average number of revisions fell from 1.8 to 0.77. The number of revisions for patients with infected shunts in the latter period was 4.07. Three hundred and eighty-four shunts were studied in the latter period for the effects of prophylactic antibiotics. No significant difference was found between the infection rate of 5.6% in the nonantibiotic group and the infection rate of 2.1% in the group receiving intravenous and intraventricular methicillin and gentamicin. Differences in the operative infection rates for patients with and without meningomyelocele and those operated on by different surgeons were not significant. The only mortalities were from nonoperative and noncerebrospinal fluid shunt causes.

Cerebrospinal Fluid Shunts↗