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At least 145 records · Page 8Linked to original sources
PubMed1978

[Own experiences in the orthopedic treatment of meningomyelocele].

30 myelomeningocele patients which were surveyed at Zurich's Children's Hospital and at the Wilhelm Schulthess Clinic in the years from 1962 to 1976 have been postexamined. Significant for the rehabilitation of these children in respect for the gaining of their best ever possible independence and capability to walk are primarily the neurosegmental level of the lesion, the remaining motor power as well as intelligence and motivation. Of secondary significance is the orthopaedic operation whereby specifically the correction of fixed deformity is important. The quantity of anesthesias should be hold at minimum, bilateral hip-dislocations can be left alone, and psoas-transfers (SHARRARD) should be made on children with strong quadriceps only.

Follow-Up Studies↗
PubMed1980

Progress in the management of the paralytic hip in myelomeningocele.

1. The primary aim of management at the hip joint in the patient with myelomeningocele is the prevention and correction of deformity, usually a flexion deformity. 2. It is necessary to treat both flexion deformity and the causative muscle imbalance; correction of this imbalance will also prevent subsequent dislocation of the lip. 3. The psoas tendon is generally excised; transfer is reserved for a few children with excellent walking potential and a good prognosis from all viewpoints. 4. Flexion deformity is treated by a soft tissue release procedure (for children under the age of eight years and for deformities of less than 45 degrees) or extension osteotomy. 5. Hip dislocation is seldom treated if it is bilateral. Whether to treat dislocation depends also on the potential of the child and the degree of dislocation.

Adolescent↗
PubMed1980

The hip in cerebral palsy.

Orthopedic surgery can alleviate the hip flexion, adduction, and medial rotation deformities of the hip and improve the function and appearance of gait. To accomplish this, however, careful examination and prudence in the operative procedure to avoid overdoing and overcorrecting are important. Orthopedic surgery can prevent subluxation and dislocation of the hip before the age of seven years, and consequently repetitive radiographic examinations of the hip in children who have spastic paralysis of the hip musculature should be a routine procedure. Subluxation and dislocation of the hip, when established, can be successfully treated with orthopedic surgical procedures. Physicians must keep in mind that the spastic paralysis of cerebral palsy originates in the brain, and therefore the spasticity cannot be eliminated. The best that can be done is to weaken or remove some muscles as deforming forces and to achieve compromises for continued function. The goal should be optimal independence for the child and adolescent during development, and freedom from pain with deteriorating function due to degenerative arthritis in the adult.

Adolescent↗
PubMedDate not supplied

Psoas abscess. A rare complication of Crohn's disease.

Psoas abscess complicating Crohn's disease is a rare condition. Fever, abdominal tenderness, limb pain and hip contracture are typical signs but only present in half of the cases. Cultures of the pus mostly grow a mixture of enterobacteria. The diagnosis is made by CT-scan. Medical therapy always results in recurrence of the abscess. Resection of the fistula and the affected bowel segment with end-to-end anastomosis is the therapy of choice. A case report is presented, followed by a review of the literature.

Adult↗
PubMed1997

Total hip reconstruction in a woman with Cornelia de Lange syndrome: a case report.

More than 250 cases of Cornelia de Lange syndrome have been reported in the medical literature, but not have described the use of hip reconstruction to correct the congenital dysplasia that may be associated with this condition. This article reports the application of a bipolar hemiarthroplasty and acetabular allograft reconstruction for a 32-year old woman with congenital dysplasia and degenerative joint disease of the hip secondary to de Lange's syndrome. On admission, she was in considerable pain and unable to bear weight on the affected extremity. Her Harris hip score was 25. Following surgical intervention and a well-designed plan of rehabilitation, the patient's functional status improved markedly. Her Harris hip score was 72, and her pain was alleviated.

Acetabulum↗
PubMedDate not supplied

Modified adductor muscle transfer in cerebral palsy.

Eighty-five patients with cerebral palsy had modified adductor muscle transfers. A study of associated patient characteristics suggests that comparing adductor transfer with adductor release using postoperative radiographs, need for subsequent surgery, or postoperative motor skills is flawed by multiple variables. Adductor release and adductor transfer are best compared by measuring the abduction obtained at surgery and maintained over time. A follow-up of 141 modified adductor transfers with no prior or concomitant hip surgery demonstrated an averaged initial improvement in abduction of 43 degrees and maintenance of abduction with a low incidence of recurrence.

Adolescent↗
PubMed1978

Scoliosis in arthrogryposis multiplex congenita.

Scoliosis was evident in eighteen of eighty-eight patients with arthrogryposis multiplex congenita. The predominant pattern of spinal deformity was a structural thoracolumbar double curve that extended to the sacrum and was associated with pelvic obliquity and lumbar hyperlordosis. Significant contractures about the hips, dislocation of the hip, or both were present in all patients but one. Most of the curves were progressive and they became rigid and fixed at an early age. There was progression of the pelvic obliquity coincident with progression of the curve. Treatment by corrective casts or a Milwaukee brace was ineffective and if surgical treatment directed at the pelvic obliquity did not correct that deformity, spine fusion to the sacrum appeared necessary.

Adolescent↗
PubMed1980

Hip and knee flexion contracture after poliomyelitis.

New cases of acute poliomyelitis continue to occur in many areas of the world and are often followed by the development of hip and knee flexion contractures in those who survive. Thorough understanding of the anatomy of the fascia lata and iliotibial band, and of the pathology involved in their contracture, is a necessity for the intelligent treatment of this condition. Operative treatment, to be adequate, must release all contracted structures and must be followed by a method of gaining and sustaining full extension.

Child↗
PubMedDate not supplied

External rotation contracture of the extended hip. A common phenomenon of infancy obscuring femoral neck anteversion and the most frequent cause of out-toeing gait in children.

External rotation contracture of the extended hip is common in young infants, decreasing progressively with growth so that it appears to be present in less than 5 per cent of the children over age 18 months. Persistence of the external rotation contracture was the main cause of toeing-out gait in this study. Femoral neck anteversion, as a cause of internal rotation posturing of the limb, does not become clinically recognizable until complete resolution of the external rotation contracture of the hip has occurred, that is, usually after 18 months of age. Femoral neck retroversion was not present clinically in any of the patients examined, and so appears to be quite rare. Approximately 80 per cent of children under 18 months of age who toe-in have internal tibiofibular torsion; most of these also have significant talar neck adductus! Approximately 70 per cent of children over age 2 years who toe-in have excess femoral neck anteversion as the cause. Approximately 75 per cent of the children with metatarsus adductus deformity have coexistent internal tibial torsion and talar neck adductus; only 25 per cent of children with internal tibial torsion have coexistent metatarsus adductus deformity. Physiologic genu varum usually occurs prior to 2 years of age and physiologic genus valgum usually occurs after 2 years of age.

Bone Diseases↗
PubMed1975

Rectus femoris release in selected patients with cerebral palsy: a preliminary report.

Two theories concerning the effects of surgical release of the proximal origins of the rectus femoris in spastic patients are (1) that release reduces hip flexion contracture and lumbar lordosis and diminishes crouch, and (2) that release primarily enhances early swing-phase knee flexion. A series of eight patients with pre-operative electromyography and pre- and post-operative dynamic knee measurements are reviewed. In these patients, back-knee thrust did not improve because it was not caused by rectus contracture. The effect upon hip was also variable: two patients had increased hip flexion and a third had diminished hip flexion after release. In six of the eight patients knee flexion was improved in early swing phase. Improvement from surgery can be expected when rectus spasticity is sufficient (1) to interfere with the initiation of swing phase, and (2) to decrease the amplitude of knee flexion. Little change occurred in the patients who did not have these functional deficits. A review of the cases supports the primary knee effect theory of Silfvenskiöld; however, insufficient information was obtained from this series to rule out hip and pelvic changes.

Adolescent↗
PubMed2000

The effect of soft tissue release of the hips on walking in myelomeningocele.

Walking and standing capacity in myelomeningocele is highly dependent on the level of the neurological lesion. Deformities, mainly flexion deformities, of the hip can severely interfere with mobility. In a retrospective study, undertaken in our hospital, we evaluated the role of soft tissue release of the hip in patients with hip flexion contractures. A special surgical technique was performed in 55 hips. The results show a good effect on verticalization, even if the hip joints cannot be extended actively. A subluxated or dislocated hip did not influence the final outcome. During the mean follow-up of approximately 4 years, only a slight recurrence of the former deformity was observed. Most of the patients obtained great advantage from the operation.

Adolescent↗