Early Bony Hip Reconstructive Surgery for Hip Subluxation in Children With Severe Cerebral Palsy.

Hip subluxation occurs frequently in children with severe cerebral palsy. This retrospective study examined the effects of age and type of bony surgery on radiographic outcomes of children with severe cerebral palsy who were treated for hip subluxation. The study included nonambulatory children with cerebral palsy undergoing bony hip reconstructive surgery consisting of proximal femoral varus derotational osteotomy (VDRO) alone or combined with pelvic osteotomy.

The single portal percutaneous epiphysiodesis technique for treatment of leg length inequality stops growth as expected.

One technique for distal femur and proximal tibia epiphysiodesis to treat leg length inequality is a single-incision percutaneous technique using reamers and curettes. The purpose of this study is to demonstrate the efficacy and reliability of this technique by quantifying the growth arrest produced from this method. Patients who underwent distal femur and proximal tibia epiphysiodesis with a single-incision percutaneous technique were retrospectively reviewed.

Bilateral Patellar Stress Fractures in a Skeletally Immature Athlete: A Case Report.

Case: This report describes the divergent course and management of bilateral patellar stress fractures in a 17-year-old skeletally immature male athlete. Beginning as bilateral incomplete tension-sided patellar fractures, the right patella healed uneventfully, whereas the left progressed to a complete, mildly displaced transverse fracture that eventually healed with nonoperative treatment measures to include temporary bracing, physical therapy, and vitamin D supplementation.

Conclusions: Patellar stress fractures are exceptionally rare, particularly bilateral injuries in the pediatric population.

Secondary Surgery Rates After Primary Fusion for Adolescent Idiopathic Scoliosis.

Instrumented spinal fusion is the gold standard treatment for surgical magnitude adolescent idiopathic scoliosis (AIS), with the goal being stable fusion without the need for additional procedures. The purpose of this study was to define the surgical return rates of AIS at a single center with respect to various instrumentation constructs used during initial spinal fusion. A retrospective chart review was performed of all patients with AIS who underwent instrumented fusion with a minimum of 2-year follow-up.

Long term gait outcomes of surgically treated idiopathic toe walkers.

Toe walking is a common gait deviation which in the absence of a known cause is termed idiopathic toe walking. Surgical treatment in the presence of a triceps surae contracture includes tendo-Achilles or gastrocnemius/soleus recession and has been shown to be effective in improving kinematic outcomes at a one year follow up. The purpose of this study was to assess longer term kinematic and kinetic outcomes of children with idiopathic toe walking treated surgically for gastrocnemius/soleus contractures.

Lumbar spine duplication: a case report.

Duplication of the spine is a rare malformation. A neurologically intact pediatric patient with this malformation is described here. A 6-year-old girl presented to our institution for evaluation of an asymptomatic kyphotic deformity.

Outcomes of Orthopaedic Surgery With and Without an External Femoral Derotational Osteotomy in Children With Cerebral Palsy.

Background: Ambulatory children with cerebral palsy (CP) often present with multiple deviations in all planes including increased internal hip rotation during gait. Excessive femoral anteversion is a common cause of deviation managed surgically with an external femoral derotational osteotomy (FDO). The purpose of this study was to evaluate the gait and functional outcomes of a group of subjects with CP who underwent surgical intervention that included an FDO compared with a match group with indications of internal hip rotation that did not receive an FDO.

Gait outcomes of patients with severe slipped capital femoral epiphysis after treatment by flexion-rotation osteotomy.

Background: Flexion-rotational osteotomy of the proximal femur is an accepted intervention in the management of severe deformity and femoral acetabular impingement secondary to slipped capital femoral epiphysis (SCFE). The impact of this surgical intervention on gait kinematics and kinetics, validated functional questionnaires, and patient outcomes has not been well studied. The purpose of this study was to analyze the changes in standard gait parameters of patients with moderate to severe SCFE who were treated with a flexion-rotational osteotomy.

Childhood obesity case statement.

Objective: The goal of this publication is to raise awareness of the impact of childhood obesity on the musculoskeletal health of children and its potential long-term implications.

Methods: Relevant articles dealing with musculoskeletal disorders either caused by or worsened by childhood obesity were reviewed through a Pub Med search. Efforts to recognize and combat the childhood obesity epidemic were also identified through Internet search engines.

A comparison of cell salvage strategies in posterior spinal fusion for adolescent idiopathic scoliosis.

Study Design: Retrospective case-control study.

Objective: To compare the efficacy of 3 blood management strategies in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) in reducing donor blood transfusion.

Summary Of Background Data: Although intraoperative cell salvage and predonated banked blood may be effective in reducing donor blood transfusion in the perioperative period, the optimal blood management strategy is unclear.

Outcomes of rectus femoris transfers in children with cerebral palsy: effect of transfer site.

Background: Distal rectus femoris transfer is a widely accepted and effective treatment for children with cerebral palsy presenting with stiff knee gait. Previous research has reported improvement in knee arc of motion regardless of transfer site; however, sample sizes and patient function were unmatched in these studies. The purpose of this study was to compare the outcomes of children with cerebral palsy treated with a distal rectus femoris transfer for stiff knee to 1 of 3 sites: medial to the semitendinosus (ST), medial to the sartorius (SR), or lateral to the iliotibial band (ITB).

Gait findings in the adolescent subject with a stiff hip.

Background: Adolescent subjects with severe unilateral hip disease are often stiff and painful yet have limited surgical options. Although hip fusion has been used successfully to minimize pain, acquired gait compensations after arthrodesis are factors felt to lead to knee and back pain over time. However, these gait compensations may already be present in a person with a stiff hip.

Childhood obesity case statement.

Objective: The goal of this publication is to raise awareness of the impact of childhood obesity on the musculoskeletal health of children and its potential long-term implications.

Methods: Relevant articles dealing with musculoskeletal disorders either caused by or worsened by childhood obesity were reviewed through a Pub Med search. Efforts to recognize and combat the childhood obesity epidemic were also identified through Internet search engines.

Gross motor development in babies with treated idiopathic clubfoot.

Purpose: To investigate the effect of treated clubfoot disorder on gross motor skill level measured by the Alberta Infant Motor Scale (AIMS).

Methods: Fifty-two babies participated: 26 were treated for idiopathic clubfoot (12 with the Ponseti treatment method, 9 with the French physical therapy technique, and 5 with a combination of both methods); 26 were babies who were typically developing and without medical diagnoses. The AIMS was administered at 3-month intervals.

Triple arthrodesis with lateral column lengthening for the treatment of planovalgus deformity.

Background: The rigid planovalgus foot has historically been difficult to correct and maintain in a corrected position with triple arthrodesis (TA). The lateral column lengthening (LCL) is a procedure that corrects the position of the planovalgus foot. Combining the TA with LCL at the calcaneocuboid joint may improve ultimate position after fusion for patients with rigid planovalgus foot deformities.

Safety of percutaneous tendoachilles tenotomy performed under general anesthesia on infants with idiopathic clubfoot.

Background: Most patients with idiopathic clubfeet require a percutaneous tendoachilles tenotomy to correct residual equinus deformity. This procedure is typically performed with the child awake in an outpatient setting. Percutaneous tendoachilles tenotomy under general anesthesia offers the potential advantages of better pain control, the ability to perform the procedure in a more controlled manner, and the possibility of lessening the pain response of the infant.

Range of motion measures under anesthesia compared with clinical measures for children with cerebral palsy.

The purpose of this study was to determine whether there is a difference in range of motion at the ankle and knee when measured in the clinic versus under anesthesia for ambulatory children with cerebral palsy. Dorsiflexion and popliteal angle were measured on 70 limbs in the clinic and under surgical anesthesia with the assessor blinded. For the group of patients under 11 years of age, dorsiflexion with the knee flexed significantly increased a mean of 9.

Gait analysis outcomes of percutaneous medial hamstring tenotomies in children with cerebral palsy.

Background: Hamstring lengthening procedures are commonly performed on children with cerebral palsy (CP) to improve gait. The purpose of this study was to determine the efficacy of percutaneous hamstring tenotomy surgery for children with ambulatory CP.

Methods: In this retrospective study, subjects were included if they had a diagnosis of CP and had computerized gait analysis data collected before and after surgery.

The pediatric outcomes data collection instrument detects improvements for children with ambulatory cerebral palsy after orthopaedic intervention.

The purpose of this study was to assess whether the Pediatric Outcomes Data Collection Instrument (PODCI) was able to detect changes in function, as perceived by the parents of children and adolescents with cerebral palsy who had undergone lower limb soft tissue and/or bony surgeries. This was a retrospective study of 80 ambulatory patients who were seen in the motion laboratory and classified with the Gross Motor Functional Classification System (GMFCS). Significant changes (P < 0.

Comprehensive outcomes of surgically treated idiopathic toe walkers.

The treatment of idiopathic toe walking in children can include surgical lengthening of the gastrocnemius/soleus complex after conservative options have been ineffective. Previous outcome reports of surgery for idiopathic toe walkers have largely been limited to assessing the sagittal plane motion of dorsiflexion/plantar flexion with minimal quantitative preoperative and postoperative analysis. The purpose of this study was to comprehensively assess the outcome of idiopathic toe walkers that had been treated surgically.

Proximal rectus femoris release surgery is not effective in normalizing hip and pelvic variables during gait in children with cerebral palsy.

The purpose of this study was to determine the efficacy of the proximal rectus femoris release to treat hip flexor contractures and hip and pelvic gait deviations in children with spastic cerebral palsy. This study was a retrospective repeated-measures analysis of data collected on two matched groups of patients, those with and without proximal rectus femoris release surgery, seen in our Motion Analysis Laboratory. Proximal rectus release surgery did not improve hip extension, did not decrease anterior pelvic tilt, and did not improve temporal-distance measures of gait in children with cerebral palsy.

Findings of fibular hemimelia syndrome with radiographically normal fibulae.

We have noted a number of patients with features of fibular hemimelia with radiographically normal fibulae. This study was undertaken to further define this group. A review of hospital records and radiographs over a 72-year period identified 149 limbs in 123 patients with features of fibular hemimelia syndrome.

Lateral subtalar dislocation in a 19-month-old female.

We report a lateral subtalar dislocation in a female 19-month-old after a minor fall. Review of the literature reveals no prior report of this injury in a patient of this age. This case illustrates the importance of thoroughly examining the pediatric patient.

Outcomes in surgical treatment of "idiopathic-like" scoliosis associated with syringomyelia.

Patients with "idiopathic-like" spinal deformities associated with syringomyelia were retrospectively reviewed. Ten patients had surgical stabilization of their curvatures with at least a 2-year follow-up, and an additional five patients were evaluated for deformity pattern with <2 years of follow-up. Paralytic curve patterns, scoliosis associated with spina bifida, congenital scoliosis, or other associated syndromes were discarded.