Intrailiac Osteotomy With Superior Lateral Outcropping Bone: A Previously Undescribed Procedure for Hip Subluxation in Cerebral Palsy.

Background: Surgical treatment of hip subluxation in cerebral palsy typically involves proximal femoral osteotomy with or without concurrent supra-acetabular pelvic osteotomy. The literature lacks data on isolated pelvic osteotomy for this condition. We present superior lateral outcropping bone as a novel procedure for augmenting pelvic osteotomies for additional femoral coverage.

Minimally Invasive Adductor Release With Obturator Block for Hip Subluxation in Cerebral Palsy: A Report of Two Cases.

Cerebral palsy (CP) is the most common motor disability in childhood and presents with spasticity, increased tone, decreased range of motion, and difficulty with ambulation. Abnormal communication between the cerebrum and the motor fibers leads to functional deficits and long-term adverse sequelae. This case report focuses on hip dysplasia.

Recurvatum of the Knee in Cerebral Palsy: A Review.

Recurvatum is defined as hyperextension of the knee in the stance phase of gait. Recurvatum knee is a naturally occurring common gait deviation in those with cerebral palsy, along with crouch knee, jump knee, and stiff knee gaits. Early and late recurvatum occur in the first and second halves of stance.

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking.

The Effect of Cerebral Palsy Disease Severity, Socioeconomic Status, and Educational Background on Selective Percutaneous Myofascial Lengthening Reoperation Rates.

Cerebral palsy (CP) is a neuro-developmental disorder. Spastic CP is the most common type of CP and is characterized by contractures of the extremities. Selective Percutaneous Myofascial Lengthening (SPML) is a minimally invasive procedure practiced by a handful of physicians in the US, and it decreases contractures and increases the range of motion in individuals with spastic CP.

Elastomeric Pain Pumps for Scoliosis Surgery.

Objective  Postoperative pain management following scoliosis surgery has traditionally relied on intravenous opioids. The objective of this study was to evaluate the effect of elastomeric pain pumps. Methods A retrospective chart review of 81 adolescent patients who underwent scoliosis surgery in a seven-year period was performed.

Acute Appendicitis After Spine Fusion for Adolescent Idiopathic Scoliosis: A Case Report.

Appendicitis is a common cause of pediatric abdominal pain, largely occurring in the second decade of life. We present the case of a 14-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis, who later developed abdominal pain, nausea, and emesis secondary to acute appendicitis. Her hospital course was significant for prolonged intravenous use of narcotics for pain control and subsequent constipation but negative for abdominal pain or tenderness during her admission.

Pre-surgery evaluations by telephone decrease travel and cost for families of children with cerebral palsy.

Introduction: Children with cerebral palsy need highly specialized care. This can be very burdensome for families, particularly in large rural states, due to the need for long-distance travel to appointments. In this study, children undergoing the selective percutaneous myofascial lengthening surgery utilized a telephone-based telemedicine evaluation to assess for surgical eligibility.

Spinal Deformities in Pediatric Burn Patients.

Introduction: Extensive third-degree burns in pediatric patients can be associated with the development of spinal deformities.

Methods: Forty pediatric burn patients with scoliosis and one with kyphosis were identified based on a retrospective review of patient records at the Shriners Hospital for Children in Galveston, Texas.

Results: Average age at time of burn was 7 years 4 months.

The use of ultrasound to determine timing of Pavlik harness discontinuation in treatment of developmental dysplasia of the hip.

The timing of Pavlik harness removal in patients with developmental dysplasia of the hip is typically determined by clinical examination. Ultrasound is considered more sensitive than clinical examination in diagnosis of instability of the hip, but it is not routinely used in cases of developmental dysplasia of the hip, especially when determining the timing of Pavlik harness removal. The purpose of this study is to investigate if ultrasound examination is more effective than clinical examination alone in determining completion of Pavlik harness treatment.

Cellular isolation, culture and characterization of the marrow sac cells in human tubular bone.

The goal of this study is to characterize the epithelioid-like human marrow sac cells that separate the myeloid and osteoblast populations in situ and to determine if they express osteoblast cytoplasmic markers. Tubular segments of femoral diaphyseal bone were obtained from healthy young (4-8 yr) male and female patients undergoing femoral shortening surgeries. The interface between bone and marrow was examined by scanning (SEM) and transmission electron microscopy (TEM).

Proximal humerus fractures sustained during the use of restraints in adolescents.

Injuries to skeletally immature individuals sustained during restraints have been rarely documented. The authors report a series of five proximal humerus fractures in skeletally immature patients (average age 15.3 years) that occurred during restraint with handcuffs.

Valgus slipped capital femoral epiphysis.

Abnormally high stresses involving the capital femoral physis were found in a series of valgus slipped capital femoral epiphysis cases. Using a single leg stance model we studied 10 hips in seven patients in which the epiphysis was lateral and posterior in relation to the femoral neck and calculated that shear stresses were high enough to be associated with failure of the physis. Valgus neck shaft angles and lateral tilt of the physes were seen in all cases.

Lateral femoral condylar shearing fractures.

Lateral femoral condylar shearing fractures occur as the aftermath of acute patellar dislocation. The fracture fragment may be larger than originally appreciated on plain films. Diagnosis depends on identifying the fracture fragment somewhere within the knee joint, and the "donor site" on the lateral femoral condyle.

The angled buckle fracture in pediatrics: a frequently missed fracture.

Buckle (torus) fractures in childhood are very common, and most assume a typical configuration wherein the trabeculae across the fracture line are compressed and the corresponding cortex bulges outward (unilateral or bilateral). In other cases the fracture merely shows cortical angulation along one side of the bone and classical buckling is not present. These latter fractures frequently are subtle and easily overlooked.

Rectus and hamstring surgery in cerebral palsy: a gait analysis study of results by functional ambulation level.

The purpose of this study is to determine if children more severely involved with cerebral palsy respond as well to rectus transfer and hamstring surgery as those with less severe involvement. Ninety-nine children were classified as independent community ambulators, crutch/walker-dependent community ambulators, or household/exercise ambulators. Maximum knee extension in stance and total range of knee motion in gait increased following surgery in all groups.

Surgical treatment of vascular malformations of the extremities in children and adolescents.

The treatment of vascular malformations (VM) of the extremities is controversial. Six patients with large, localized, symptomatic VMs of the extremities underwent surgical excision. In five cases abnormal vessels were apparent under the skin; in two of these there was also red discoloration of the skin secondary to skin involvement.

Foot progression angle after distal tibial physeal fractures.

Twenty-three patients with Salter 1 or 2 fractures of the distal tibia had follow-up with footprints to assess rotational deformities. Fourteen had external rotation deformity >+2 SD of the normal mean of 5 degrees to 6 degrees. Eight of the 14 had the finding of physeal widening of 2 mm or more.

Abdominal reflexes.

Examination of the superficial abdominal reflexes in patients thought to have idiopathic scoliosis has been considered possibly beneficial for deciding who should have magnetic resonance imaging to rule out syringomyelia. The purpose of this study was to determine what is normal for this examination. Thirty normal adolescents and 35 normal young adults underwent testing of the superficial abdominal reflexes and the patellar and Achilles deep tendon reflexes.

Vulpius and Z-lengthening.

An evaluation of ankle function in gait after 22 Vulpius lengthenings of the gastrocnemius fascia and 27 Z-lengthenings of the Achilles tendon was performed in 33 ambulatory cerebral palsy patients. Simultaneous hip or knee surgeries or both were performed in most instances. Gait analysis including ankle motion, moment, and power data was obtained before surgery and approximately 1 year after.

A comparison of Wisconsin instrumentation and Cotrel-Dubousset instrumentation.

Twenty-six patients who underwent Wisconsin instrumentation and 36 patients who underwent Cotrel-Dubousset instrumentation (CDI) for idiopathic scoliosis were studied. Inclusion in the study required at least 24-month follow-up. Variables compared included operating time, blood loss, frontal plane correction, axial and sagittal plane changes, effects on compensation, and complications.