Results of muscle release for lateral hip migration in cerebral palsy

An adductor longus and gracilis muscle release procedure combined with anterior branch obturator neurectomy was reviewed in 36 children with cerebral palsy and lateral migration of the hip. The aim was to evaluate the results clinically, functionally and radiologically. There were 24 males and 12 females [average age 4.5 years]; 75% were diplegics, 22.2% quadroplegics and 2.8% hemiplegics. All the patients but one was spastics. The results have shown that muscle release with anterior branch obturator neurectomy was effective in improving or preventing further lateral migration of the hip. Subsequent adduction contracture developed in two cases [5.5%]. The results in the remaining patients were judged clinically satisfactory as abduction remained in an acceptable range. There was significant functional improvement in seven cases [16.6%]. The best results were achieved in Patients who were less than 6 years of age at the time of surgery. It was concluded that. management of lateral migration of the hip in cerebral palsied children by muscle release combined with anterior branch obturator neurectomy was safe and effective in preventing further migration

Possible causes of failure in the management of acute osteomyelitis in Saudi Arabia

Twenty-four cases of acute osteomyelitis in which primary treatment of the patients was unsuccessful were reviewed. The aim was to analyse the possible causes of failure and to identify means of minimizing their occurence. There were 83.3% males, 16.7% females, with an average age of 6 years. All patients were initially treated by a combination of erythromycin and fucidin. Surgical intervention was carried out in 75% of the cases. The causal organisms were Staphylococcus aureus [the commonest] Streptococcus haemolyticus, Escherichia coli, Brucella and Pseudomonas. Late presentation and diagnosis, ineffective immobilization, surgical intervention and treatment due to an unusual causal organism [brucella] were the principal causes of failure. It was concluded that the following steps are necessary to minimize the risks of complications: [1] a public health education Programme to stress the value of early medical consultation; [2] continuation of effective immobilization until clinical cure and a fall of sedmentation rate has occurred; [3] radiological localization of site infection by isotope scan in clinically difficult cases; and [4] generation of a high index of suspicion of brucellosis as a causal organism in endemic areas

usual and the unusual presentation of Ewing's sarcoma

We conducted a review of 14 patients with an established histological diagnosis of Ewing's sarcoma in order to analyze the clinical and radiological features of the disease as observed at King Khalid University Hospital and to compare them with those reported in the literature. There were 9 males and 5 females, and the average age was 11 years. All patients but one complained of a painful swelling. Symptoms had lasted an average of 4 months and 50% of the patients had a history of trauma. The radiological appearance varied according to the bone and the part of the bone involved. Only 36% of the patients exhibited the classic appearance. Based on the clinical and radiological findings, the provisional diagnosis of Ewing's sarcoma was accurate in 50% of the cases. Other diagnoses included osteomyelitis, trauma, osteosarcoma, and actinomycosis. Ewing's sarcoma may mimic a variety of conditions, and although a combination of painful swelling seen clinically and a destructive lesion shown radiologically in an immature skeleton should confirm the diagnosis, variations from the usual features do occur

cost-effective paediatric orthopedic table

The application of a hip spica plaster cast in children is a common procedure. The indications are many, but it is most often used in the management of patients with congenital hip dislocation and fractures of the femoral shaft. For this purpose the table described has been designed to allow the surgeon to perform manipulations, screen the patient radiologically and then apply the hip spica plaster cast with minimal disturbance to the patient. This simple design is based on two sliding parts, one for manual examination and X-ray screening and the second for plaster application