ABSTRACT
Abstract Objective To perform a retrospective and cross-sectional assessment to determine the pain and positional improvement of all patients with spastic cerebral palsy (CP) and severe hip deformity who underwent a McHale procedure in our center. A second objective was to analyze the potential complications from the procedure. Methods All consecutive patients treated between 1995 and 2017 were analyzed. Clinically, the patients should present pain on hip mobilization, difficulty in positioning for sitting and hygiene care, and medical records with complete data; functionally was assessed through the Gross Motor Function Classification System (GMFCS). In the preoperative radiographs, we analyzed the migration percentage (MP), the type of deformity according to the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS), and the type of deformity of the femoral head. After the surgery, we assessed the proximal migration of the proximal femoral fragment, implant changes and/or failure, and potential heterotopic ossification. The outcomes were reported as successful (D1) in patients presenting remission of pain, painless mobility, and improved positioning, or unsuccessful (D2) in those presenting procedural failure that required a new surgery. Results In total, 47 patients (53 hips) were treated. Functionally, 43 patients were classified as GMFCS V (91%), 3 as GMFCS IV patients (6%), and 1 as GMFCS III (2%). The mean age was 13 years and 2 months. The follow-up ranged from 1 year to 15 years and 4 months, with an average of 4 years and 8 months. A total of 36 patients (41 hips) presented successful (D1) outcomes after the McHale procedure, corresponding to 77% of our cases, whereas 11 (23%) cases had unsuccessful (D2) outcomes. Conclusion The McHale procedure is a treatment option for GMFCS IV and V, but we must be aware of the potential complications.
Resumo Objetivo Fazer uma avaliação retrospectiva e transversal quanto à melhora da dor e do posicionamento de todos os pacientes portadores de paralisia cerebral (PC) espástica com deformidade grave no quadril submetidos ao procedimento de McHale em nosso centro. Secundariamente, objetivou-se analisar as possíveis complicações do procedimento. Métodos Foram analisados todos os pacientes consecutivos tratados no período entre 1995 e 2017. Clinicamente, os pacientes deveriam apresentar dor à mobilização do quadril, dificuldade de posicionamento para se sentar e para os cuidados de higiene, e prontuário médico com dados completos; quanto ao grau de função motora, utilizou-se o Sistema de Classificação da Função Motora Grossa (Gross Motor Function Classification System, GMFCS, em inglês). A avaliação radiográfica no período pré-operatório analisou a porcentagem de migração (PM), o tipo de deformidade de acordo com a Escala de Classificação de Quadril na Paralisia Cerebral de Melbourne (Melbourne Cerebral Palsy Hip Classification Scale, MCPHS), e a deformidade da cabeça femoral. No período pós-operatório, analisaram-se a presença de migração proximal do fragmento do fêmur proximal, as alterações e/ou a falha do implante utilizado, e a possível ossificação heterotópica. Consideraram-se como desfechos: D1- satisfatório: remissão da dor, mobilidade indolor, melhora do posicionamento; e D2- insatisfatório: falha no procedimento, que necessitou de reabordagem cirúrgica. Resultados No total, 47 pacientes (53 quadris) foram tratados. Funcionalmente, quanto à classificação no GMFCS, 43 pacientes eram GMFCS V (91%), 3 pacientes eram GMFCS IV (6%), e 1 paciente era GMFCS III (2%). A média da idade foi de 13 anos e 2 meses. O tempo de seguimento variou de 1 ano a 15 anos e 4 meses, com média de 4 anos e 8 meses. Quanto ao desfecho da cirurgia de McHale, ele foi satifatório (D1) em 36 pacientes (41 quadris), perfazendo 77% dos nossos casos, e insatisfatório (D2) em 11 (23%) casos. Conclusão A cirurgia de McHale é uma opção no tratamento para os níveis IV e V, mas devemos estar alertas para as possíveis complicações.
Subject(s)
Humans , Male , Female , Postoperative Period , Congenital Abnormalities , Cerebral Palsy , Retrospective Studies , Hip/abnormalities , Hip/surgery , Muscle SpasticityABSTRACT
Abstract Objective The purpose of the present paper is to compare the equivalence of the measurement of the alpha angle using the Ducroquet and cross-table lateral views. Methods We have recruited 90 patients, resulting in 95 hips. We have standardized the realization of the radiographic views. The incidence of the lateral cross-table views were takenwith 15° of internal rotation with the patient in the supine position, and the incidence of the Ducroquet viewswas standardizedwith the patient in the supine position,with 90° of flexion and 45° of abduction of the hip. The alpha angle wasmeasured in both lateral views, by two musculoskeletal radiologists. The measurements were performed in 2 different times: an initial evaluation andanother 4weeks afterwards. The t Student test was usedand calculated the intraclass correlation coefficient (ICC). Results We have found a good intraobserver correlation for both views in different times; there was no statistically significant difference between the measurements performed by the two views. However, the interobserver correlation was low. Conclusion In conclusion, the Ducroquet profile view is a good choice for the α angle measurement and can be used instead of the cross-table view.
Resumo Objetivo O objetivo do presente trabalho é comparar a equivalência da medida do ângulo alfa do quadril usando as incidências laterais de Ducroquet e de cross-table. Método Estudamos 90 pacientes, com um total de 95 quadris, e padronizamos a realização das radiografias conhecidas como "Ducroquet" e "cross-table." A incidência de perfil de cross-table foi realizada em 15° de rotação interna com o paciente em posição supina, e a incidência de perfil de Ducroquet foi padronizada com o paciente posicionado em decúbito dorsal, em 90° de flexão e 45° de abdução do quadril. O ângulo alfa foi medido em ambas as radiografias de perfil, por dois radiologistas especializados em afecções musculoesqueléticas. As medidas foram realizadas em 2 épocas diferentes: uma avaliação inicial e outra após 4 semanas. O teste t de Student foi utilizado e calculou o coeficiente de correlação intraclasse (CCI). Resultados Encontramos boa correlação intraobservador para ambas as incidências radiográficas em diferentes momentos. Não houve diferença estatisticamente significante entre as medidas feitas pelas duas visualizações. No entanto, a correlação interobservadores foi baixa. Conclusão A incidência radiográfica de perfil de Ducroquet é uma boa opção para a medida do ângulo alfa e pode ser usada ao invés da incidência radiográfica de perfil cross-table.
Subject(s)
Humans , Male , Female , Radiography , Femoracetabular Impingement , Hip/abnormalities , Hip/diagnostic imagingABSTRACT
The gemelli are deep muscles, which act together with the obturator internus muscle, stabilizing dynamically the hip joint. In the present article, a case of bilateral absence of both gemelli muscles in the pelvis of a female cadaver is described. A possible embryological explanation of this condition is discussed, besides its clinical and surgical importance.
Los gemelos son músculos profundos, que actúan junto al obturador interno estabilizando dinámicamente la articulación de cadera. En el presente artículo se describe un caso de ausencia bilateral de ambos músculos gemelos en la pelvis de un cadáver femenino. Se discute la posible explicación embriológica de esta condición y su importancia clínica y quirúrgica.
Subject(s)
Humans , Female , Anatomic Variation , Hip/abnormalities , Muscle, Skeletal/abnormalities , CadaverSubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Hip/abnormalities , Hip/growth & development , Hip/pathology , Hip , Hip Dislocation, Congenital/diagnosis , Hip Dislocation, Congenital/therapy , ArgentinaABSTRACT
Limping is a debilitating problem that can be prevented by screening at risk newborns. Jaundice is a problem that brings approximately one fifth of newborns to hospital in early infancy. The aim of this study was to find out whether the newborns with physiologic jaundice are at an increased risk of developing developmental dislocation of hip and whether it is logical to screen these newborns with Graf's ultrasonographic method. Throughout a year, 320 icteric newborns [640 hips] that referred to Nemazee Hospital Neonatal Emergency Room for checking their bilirubin were screened by Graf's ultrasonographic method for developmental dislocation of hip [DDH]. Any newborn with other problems such as congenital anomalies were excluded form this study. Of the 640 hips, 21 newborns [3.28%] had a dysplastic hip [Class IIa] that needed follow up and 12 from them came back for follow up of hip ultrasongraphy, all of whom became normal [Class Ia] without treatment. Only 1 hip did have severe dysplasia [Class IIc] [.16%] that needed treatment at the time of discovery. The rate of DDH seems not to increase in the newborns with physiologic jaundice. It seems not to be logical to screen newborns with physiologic jaundice with Graf's ultrasonographic method, if screening is not cost-effective
Subject(s)
Humans , Male , Female , Bone Diseases, Developmental/diagnosis , Bone Diseases, Developmental/epidemiology , Infant, Newborn , Ultrasonography , Hip/abnormalities , Jaundice, Neonatal , Hip Dislocation, Congenital/diagnostic imagingABSTRACT
La displasia del desarrollo de caderas (DDC) es una entidad que puede desarrollarse en el período prenatalo posterior al nacimiento. Está determinada en gran parte por factores mecánicos que actúan sobre la cadera y su aparato de sostén, el que puede ser normal o presentar una laxitud aumentada, lo cual puede conducir a inestabilidad articular y eventualmente luxación permanente, pasando por todos los rangos intermedios. De esta manera, los cambios morfológicos de la cabeza femoral y del acetábulo serían secundarios y se desarrollarían en el transcurso del tiempo.
Subject(s)
Child , Hip/abnormalities , Hip Dislocation , Hip Dislocation, Congenital/geneticsABSTRACT
Surgical correction of infantile coxa vara can be achieved through valgus osteotomies, but recurrence ranges from 30-70%. Several previous studies have concluded that the single most important factor preventing recurrence of the deformity following surgical correction is to achieve an Epiphyseal-Hilgenreiner angle, [EHA] of 35-40°. This study evaluates the outcome of surgical correction of infantile coxa vara using an intertrochanteric Y-shaped valgus osteotomy. Eight children [nine hips] underwent an intertrochanteric Y-shaped valgus osteotomy for correction of infantile coxa vara. The age at time of surgery ranged from 4-8 years [average 5.4 years]. All hips had improvement of the immediate and final follow up EH A. In eight hips the EH A was corrected to
Subject(s)
Humans , Male , Female , Hip/abnormalities , Child , Osteotomy , Follow-Up Studies , Treatment Outcome , Internal FixatorsABSTRACT
Se ha revisado la experiencia del Hospital Universitario de Caracas en los últimos 11 años (1986-1996) en las grandes desarticulaciones encontrándose sólo 18 casos, la mayoría de ellos (16) son desarticulaciones de la cadera, una hemipelvectomía y una desarticulación interescápulo torácica. Se analizan también, más detalladamente, 2 casos de grandes desarticulaciones preservadoras: una operación de Tikhoff-Linberg y una hemipelvectomía interna por razones ortópedicas, operado exitosamente en el Hospital de Clínicas Caracas
Subject(s)
Humans , Disarticulation/adverse effects , Hemipelvectomy/adverse effects , Hip/abnormalities , Tomography/adverse effects , Thorax/abnormalities , Ulcer/complicationsABSTRACT
Se presentan 10 casos con displasia acetabular, secundaria a displasia del desarrollo de la cadera, en los cuales se realizó la acetabuloplastía de repisa con la técnica se Spitzy-Funayama, todos del sexo femenino, con edades de 4 años 6 meses a 13 años 4 meses, con seguimiento mínimo de 5 meses y máximo de 3 años 3 meses, valorando pre y postoperatoriamente la marcha y movilidad las cuales no se modificaron, un caso presentó dolor peoperatorio, el cual desapareció con la cirugía. Radiográficamente se valoró el ángulo de Wiberg, pre, transoperatorio y postoperatorio con medio inicial de 7.5 grados y final de 37.5 grados. El porcentaje de cobertura medio inicial de 54.5 por ciento y medio final de 93.5 por ciento
Subject(s)
Humans , Female , Child, Preschool , Adolescent , Gait , Hip/abnormalities , Hip/surgery , Acetabulum/surgeryABSTRACT
É muito difícil se determinar as condiçöes de normalidade, em relaçäo ao desenvolvimento do quadril desde, seu molde embrionário até a sua completa formaçäo. Existe muita controvérsia na literatura quanto ao aparecimento do núcleo de ossificaçäo secundário da epífise femoral nos quadris normais, visto que este pode aparecer desde os primeiros dias de vida (Jacobs, 1966), até um ano e meio após o nascimento (Paterson, 1976). Os autores apresentam o relato de um paciente de um ano e nove meses de idade, que näo apresentava a ossificaçäo da epífise femoral proximal, tratando-se provalvemente de um retardo do aparecimento do núcleo primário. O que foi comprovado após um seguimento clínico, ultra-sonográfico e por ressonância magnética, após um seguimento de um ano e nove meses
Subject(s)
Humans , Male , Infant , Epiphyses/abnormalities , Femur , Femur/embryology , Hip , Hip/abnormalities , Hip/embryology , Hip Dislocation, Congenital/embryology , Hip Dislocation, CongenitalABSTRACT
We added hydrotherapy to 50 patients with spinal muscular atrophy (SMA) who were being treated with individual convencional physiotherapy. Hydrotherapy was performed at an approximate temperature of 30 degrees Celsius, twice a week, for thirty minutes in children and for forty-five minutes in adults during a 2-year period. The outcome derived from this combined modality of treatment was rated according to physiotherapeutic evaluations, the MMT (Manual Muscular Test), and the Barthel Ladder. Patients were reevaluated at 2-month intervals. After two years of ongoing treatment, we were able to observe that the deformities in hip, knee and foot were progressive in all SMA Type II patients, and in some Type III. Muscle strength stabilized in most SMA Type III patients, and improved in some, MMT was not done in SMA Type II. In all patients we were able to detect an improvement in the Barthel Ladder scale. This study suggests that a measurable improvement in the quality of daily living may be obtained in patients with SMA Types II and III subjected to conventional physiotherapy when associated with hydrotherapy.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Hydrotherapy , Muscular Atrophy, Spinal/rehabilitation , Physical Therapy Specialty , Congenital Abnormalities/rehabilitation , Foot Deformities/rehabilitation , Hip/abnormalities , Knee/abnormalities , Kyphosis , Motor Activity , Scoliosis , Swimming Pools , Time FactorsABSTRACT
Se presenta un caso poco frecuente en el cual se implantan sistemas de tornillo dinámico en ambas caderas y rodillas de un mismo paciente. El uso múltiple de DHS (Dinamic Hip Screw) y DCS (Dinamic Condilar Screw) favoreció la óptima consolidación de la fractura y la rehabilitación precoz
Subject(s)
Humans , Male , Middle Aged , Femur/abnormalities , Fractures, Bone/classification , Hip/abnormalities , Rehabilitation/classification , Patella/abnormalitiesABSTRACT
Three Saudi children [two female, one male] are described who presented with familial arthropathy associated with congenital camptodactyly. This rare but recognized clinical entity has a variable clinical presentation and may be associated with pericarditis and coxa vara. Camptodactyly was observed in the neonatal period in all patients, while joint swelling was observed between the third and 11th month. Pericarditis was suspected in the referral hospital in one patient but was not subsequently confirmed at our institution, raising the possibility that pericarditis may be reversible. Radiological examination of the hips showed coxa vara with short femoral neck in all patients. Synovial biopsy in the three patients revealed proliferating synovial epithelium with moderate fibrocollagenous densities and multinucleated giant cells, occasional lymphocytes or neutrophils but no plasma cells were identified. This is the first series of this familial arthropathy with a triad of camptodactyly, arthropathy and coxa vara [CAC syndrome] in Saudi Arabia which is to be considered in patients where more than one family member has juvenile arthritis
Subject(s)
Arthropathy, Neurogenic/diagnosis , Hip/abnormalities , SyndromeABSTRACT
As causas mais frequentes na etiologia do andar anormal da criança säo as deformidades torsionais dos membros inferiores. Elas ocorrem tanto no fêmur como na tíbia e säo responsáveis pela postura anormal dos membros inferiores quando a criança anda. A origem destas deformidades está no posicionamento intrauterino e a sua manifestaçäo clínica ocorre durante os primeiros anos de vida. De maneira geral, estas deformidades regridem natural e espontaneamente com o crescimento. Posturas anormais tanto de dormir como de sentar, adotadas pela criança nos primeiros anos de vida, impedem que ocorra a regressäo espontânea e contribuem para perpetuar a deformidade. O tratamento raramente está indicado porém o diagnóstico preciso é fundamental para que se possa estabelecer o prognóstico e desta maneira tranquilizar os pais
Subject(s)
Humans , Child, Preschool , Hip/abnormalities , Perna/abnormalities , Posture/physiologyABSTRACT
14 patients with 18 neglected congenital dislocation of the hips were treated by one stage operation. The average age was 5-years and 2 months. In the majority of these cases, open reduction, Salter Osteotomy and femoral shortening were carried out. Post operatively the hip was immobilized in plaster one and one-half spica for 6 weeks then in Broom stick abduction splint for further 6 weeks.Post cast removal, the patients were put on intensive physiotherapy program for mobilization of the hips. The surgical procedure was mentioned. Despite the short term follow up, the initial results were very encouraging
Subject(s)
Congenital Abnormalities/surgery , Hip/abnormalitiesABSTRACT
En un paciente con parálisis cerebral hay un desbalance muscular progresivo que en la cadera lleva primero a aducción, posteriormente a flexión y rotación interna; y si el desbalance es grave y persisten las posturas viciosas, se producirán cambios adaptativos en partes blandas y óseas aumentando la anteversión y el valgo del fémur pudiendo evolucionar a subluxación o luxación. En pacientes con parálisis cerebral se realizó 302 procedimientos quirúrgicos en cadera; y en el presente trabajo evaluamos 92 caderas en 46 pacientes en los que se ha realizado tenotomía de aductores, recto interno y/o neurectomía de ramas anteriores de obturadores, complementando luego con ejercicios activos y pasivos de caderas y rodillas. En los pacientes no ambulatorios se logró mejorar los cuidados de enfermería en el 95 por ciento de operados; y en los ambulatorios además se mejoró la marcha en el 92 por ciento; y el índice de migración en el 70 por ciento
Subject(s)
Humans , Male , Female , Child, Preschool , Cerebral Palsy/complications , Cerebral Palsy/diagnosis , Cerebral Palsy/etiology , Peru , Surgical Procedures, Operative , Tendons/surgery , Hip/abnormalities , Hip/surgery , Hip , Muscle Spasticity/diagnosis , Muscle Spasticity/etiology , Muscle Spasticity/therapy , Hip Dislocation/surgery , Hip Dislocation/etiology , Hip Dislocation/therapyABSTRACT
O A. analisa a dificuldade em se determinar a causa do descenso do ângulo de inclinaçäo do colo femoral, tendo sido sugerida por ele uma teoria baseada na evoluçäo neuromuscular. Pesquisou-se a freqüência da coxa valga em 65 pacientes com paralisia cerebral, correlacionando-a aos seus tipos clínicos, à sua distribuiçäo topográfica, à idade cronológica, à deambulaçäo e ao tempo decorrido desde o início da deambulaçäo. Observou-se, nesses pacientes, que a freqüência da coxa valga é alta, sendo mais vista na infância até a puberdade, e que ela näo se correlaciona a nenhuma das variáveis pesquisadas. Como o único fato comum, observado em todos os pacientes, foi o atraso do desenvolvimento neuromuscular, o A. conclui que näo se pode excluir a imaturidade neuromuscular como causa da coxa valga na paralisia cerebral
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Humans , Cerebral Palsy , Femur Neck , Hip/abnormalitiesABSTRACT
1. The operative treatment of flexion deformity hip after poliomyelitis gave 83.33% satisfactory result. 2. Satisfactory result was more when the angle of deformity was less than 30 degrees. 3. The presence of associated flexion deformity knee is a cause of unsatisfactory result. 4. Soutter's operation is most suitable in flexion deformity less than 30 degrees. 5. Compell's operation is more suitable when the flexion deformity is more than 30 degrees. 6. Yount oepration had the least satisfactory result and can be used only as supplementary procedure to the two other operations