Soft-tissue Releases to Treat Spastic Hip Subluxation in Children with Cerebral Palsy: Effect of Age at the Time of Surgery / The Japanese Journal of Rehabilitation Medicine

Objectives : Muscle imbalance poses a problem for adequate motor function in patients with cerebral palsy. The adductor and flexor muscles around the hip become dominant, leading to a high risk of hip dislocation. When left untreated, flexion and adduction contracture progresses, leading to various impairments ; hence, it is important to undertake preventive measures at an early stage. Selective muscle release is one form of surgical treatment that has been proven effective, but there is no consensus on the timing of the surgery. Here, we investigated the difference in outcome after muscle release surgery with respect to age. Subjects and methods : The subjects were 26 patients (52 hips) from our medical center who underwent muscle release (partial modification of Matsuo's method) around the hip and were followed up for at least 6 months. Abduction was retained postoperatively by using a cast or prosthetic device. Migration percentage (MP) was measured by simple hip radiography image, and the rates of improvement (preoperative MP . final MP during observation/preoperative MP ×100%) were compared. Results : Higher rates of improvement were observed among patients aged 5 years or less at the time of surgery than those among patients aged 6 years or more. Conclusion : We consider that surgery performed at the age of 5 years or less could lead to favorable results.

Efficacy of the Preventive Abduction Brace in Dementia Patients After Bipolar hemiarthroplasty of the Hip

Purpose: To evaluate the efficacy of the preventive abduction brace in dementia patients after bipolar hemiarthroplasty of the hip. Materials and Method: A review of 30 patients who had dementia prior to bipolar hemiarthroplasty of the hip. 20 females and 10 males were evaluated and their mean age was 80.4 years old (range, 68 to -92 years old). The average MMSE-K in dementia patients was 14.2 (range, 8 to 20). The reasons for the bipolar hemiarthroplasties were femoral neck fractures in all the cases. We analyzed the dislocation rates of those who had preventive abduction braces applied prospectively. Results: The average follow-up period after hemiarthroplasty was 2.2 years. All 30 patients had preventive abduction braces and no dislocations occurred after the bipolar hemiarthroplasties. Conclusion: Hip dislocations were not detected in those patients who preventive abduction braces applied. The present findings suggest that having a preventive abduction brace will definitely reduce the dislocation rate in dementia patients who have difficulties with rehabilitation after their operations.

Treatment of Chidren's Fracture of Surgical Humerus Neck with Abduction Brace Combined with Mani-pulative Reduction / 实用儿科临床杂志

Objective Retrospective analysis of 56 cases of the surgical humerus neck of children that treated with abduction brace combined with manipulative reduction,and discuss the significance of abduction brace combined with manipulative reduction in treatment of fracture of the surgical humerus neck about children.Methods This study consisted of 56 children with fracture of the surgical humerus neck,among these,41 were males and 15 were females,9 were road accident and 47 were falling injury,average 7.67 years.They were all treated with abduction brace combined with manipulative reduction,after 1 month fixation,dismantled the abduction brace and did the functional exercise.Results Follow-up study was carried out in 56 cases,followed 6 months to 5 years,average 2.96 years,accoding to the standard of fracture healing,excellent result was obtained in 35 cases and good in 21 cases,the excellent-good rate was 100%.Conclusions Abduction brace combined with manipulative reduction is an effective treatment for fracture of the surgical humerus neck in children.