Management of equinus in cerebral palsy

The equinus accompanying cerebral palsy occurs as a result from tendo calcanius contracture, which results in difficulty in dorsal flexion of foot in ankle joint. The goals of this research are: A-selection of appropriate management for the equinus in cerebral palsy. B-the possibility of reducing the complication rate; as infections, recurrence and aggravation of deformity. C-definition of the ideal timing for such procedures. A-significant frequency of these cases. B-diagnosis accuracy, especially in early aged-patients. C-definition of the ideal timing for the management, either conservative or surgical. There were/50/cases of equinus in cerebral palsy documented in/28/patients, who followed up for/14/months approximately/from 6 to 26 months/Male for female 3:1, ratio was/males were 21 patients, werease females were71. The cases were classified on basis of central nervous system development, into two groups; A-first group:/7 years or less/B-second group:/older than 7 years/All the data related to those patients are obtained from their files. The cases which were not complete documented have ruled out. Subsequent follow up carried out during the period mentioned above. -Males percentage in this study was/71.4%/whereas females accounted for/28.6%/. -There were two age subdivisions one under/7/years, and the other was older than that. -All studied cases accounted for/50/, 36 cases have classified as first subdivision/72%/, and the rest of the cases/14/cases/has classified as the second one/28%/-Patients age average was 8.053 years. The youngest one has aged two years, and the oldest was 26 years. -The most potential diagnostic technologies were clinical when diagnosis of equines and cerebral palsy was firmly established. -Conservative management was carried out in 7 cases only; all of them were first subdivision. Surgical intervention was carried out in 43 patients from both of the subdivision. Conservative management included periodic casts for/3-6/months, and then followed by AFO until long bones growth is completed. -Surgical procedures varied, the simplest one was elongation of tendo calcanius in z-shape with or without medial and posterior capsulotomy the, percentage was 44.1% in 19 equnius cases. -The results which have been observated were as the following: A-GOOD RESULTS: the equnius deformity was corrected completely in 4. foots/which means 80% from all studied foots/B-MODEATE RESULTS: in these cases the equnius deformity was corrected in spite of the presence of mild pain during walking in 6 foots/12% of all studied foots/C-BAD RESULTS: the deformity has not corrected and there were claudation and moderate to sever pain in 4 foots/8% of all studied foots/Postoperative Complications Were: A-Osteoarthritis in 12 foots/24%/. B-Scarring in 4 foots/9.3%/. C-Wound infection in 6 foots/13.9%/. D-recurrence in 7 foots/14%/. E-skin necrosis in 3 foots/6.9%/. F-two foots had abscesses/4.6%/. G-chonic pain in 4 foots/8%/. -This study of Aleppo University Hospital was compared with two studies; the first was carried out in Saint-Etheian University-France/2000/and Carl-Francis-Gras, Austria./2000/. -The studied cases in the both studies accounted for 48 foots, 28cases were treated surgically, and the rest conservatively. -The procedures have undergone in those centers were: Z-PLASTY, VALPIUS, STRAYER, BAKER, and the most common procedure was VALPIUS in 7 patients who had I.foots with deformity/35.7%/

Estudo da tendência de malformaçöes ortopédicas em uma maternidade assistencial (1.000 recém-nascidos avaliados) / Study of the trends of orthopedic malformations in a assistential maternity (evaluated newborn 1.000)

Estudamos 1.000 recém-nascidos vivos em uma maternidade (Instituição Amparo Maternal) voltada para a população carente no período de setembro de 1997 a julho de 1998. Nesse período catalogamos os recém-nascidos por meio de um protocolo que constou dos antecedentes pré-natal e natal e do exame de seis horas. Nossa intenção foi a de analisar o número de recém-nascidos que apresentaram alguma alteracão fenotípica ao nascimento bem como correlacionar os achados com as alterações observadas no exame físico. Catalogamos os recém-nascidos conforme a anomalia encontrada e outros fatores os quais julgamos relevantes, como idade materna, Apgar, peso ao nascimento, idade gestacional, sexo do recém-nascido, peso ao nascimento, tipo do parto e apresentação.Selecionamos 265 recém-nascidos que foram submetidos ao exame físico ortopédico. Encontramos 14 recém-nascidos com algum tipo de malformação entre os 1.000 catalogados, apresentando um total de 16 malformações. Cinco (0,5 por cento) recém-nascidos apresentaram polidactilia, dois (0,2 por cento) pé equino-cavo-varo não-sindrômico, dois (0,2 por cento) pé-equino-cavo-varo sindrômico, dois (0,2 por cento) pé calcâneo valgo, um (0,1 por cento) metatarso adulto, dois (0,2 por cento) artrogripose e dois (0,2 por cento) dedos sobrepostos.

Cirugia de Evans I / Evans I surgery

Como manifiesta el Dr. Evans en su articulo original la operacion descrita tiene dos propositos que son: Primero, el proveer un metodo satisfactorio para manejar la recidiva del pie equino varo congenito y ofrecer una evidencia experimental de la validez de la teoria que cualquiera que sea la etiologia del pie equino varo congenito, la deformidad esencial es el desplazamiento medial o una rotacion del escafoides sobre el astragalo. La recidiva se presenta en la recurrencia de este desplazamiento, o mas probablemente de fallas al corregirlo completamente en las manipulaciones previas. Es asi como se debe encaminar la correccion del pie equino varo congenito a reducir el escafoides sobre la cabeza del astragalo y una vez hecho lo anterior, el cuboides habra sido empujado lateralmente y habra tapado con la parte anterior y final del calcaneo, el cual quedara libre de la parte anterior y final del astragalo; el talon se movera al valgo y se habra aclarado el camino para la correccion del equino. Por lo tanto, si llega a ser evidente que el pie esta recidivado, el tratamiento debe comenzar de nuevo, pero es obvio que en esta etapa la resistencia ofrecida por el pie ha llegado a ser muy grande y la correccion completa es a menudo imposible. Existe aqui un fenomeno de sobrecrecimiento relativo de la columna lateral del pie que impide una correccion satisfactoria de la deformidad primaria y es aqui donde el autor se detiene y hace un analisis cuidadoso de lo que ofrece la reseccion de una cuna en la articulacion calcaneo-cuboidea. Se concluye por su trabajo, por los autores (pocos) y por el presente, el buen resultado, ...