Current Concept and Management of Spastic Hip in Children: A Narrative Review.

Cerebral palsy (CP) is a non-progressive motor condition that hinders the development of movement and posture. One of the common problems faced in CP is spastic hips, which can cause discomfort, deformity, and functional restrictions. This review article seeks to offer a thorough summary of the most recent methods for treating spastic hips in cerebral palsy patients. Additionally, it describes the success and potential risks of various conservative and surgical procedures. It also looks at new treatments and potential avenues for managing this complicated ailment.

The use of extracorporeal shock wave therapy (ESWT) in treating osteonecrosis of the femoral head (AVNFH): a retrospective study.

PURPOSE: As most of the cases of avascular necrosis (AVN) in Saudi Arabia is seen in young population and as literature showed good effect of extracorporeal shock wave therapy (ESWT) in reducing pain and oedema in avascular necrosis and delaying the need of surgical intervention. Our purpose of this study is to assess the effectiveness of ESWT in reducing pain, improving range of motion (ROM) and delaying the surgical intervention in patient with AVN of femoral head and compare our results to published literature. MATERIAL AND METHODS: We have treated 24 patients, 13 males and 11 females with a mean age of 29 years (range 14-48) with 34 hips affected. There were 14 unilateral and ten bilateral lesions. In our series 11 out of 24 patients (45.8%) were due to sickle cell disease. Other causes included idiopathic in five patients (20.8%), corticosteroids use and systemic lupus erythematous in three patients each (12.5% each) and post-traumatic AVN in two patients (8.3%). Extracorporeal shock wave therapy was implanted in FICAT stage I, II and III. All patients had two sessions of extracorporeal shock wave therapy, four to six weeks apart, each with 4000 impulses divided into four points. Radiological and MRI assessment were performed at regular time intervals with a minimum follow-up of two years. Clinical assessment was based on Visual Analog Scale and Harris Hip Score (HHS). The end point outcome measurement was the need for any operative intervention. RESULTS: Operative intervention was necessary in eight out of 34 hips (23.5%), within an average of 2.5 years (range 1 to 5 years). A hip salvage was achieved in 76.5%. Function was improved with the Harris Hip Score from a mean of 54.6 to 80.4 (P value using paired t test ≤ 0.05). Pain assessed with Visual Analog Scale improved from 5.73 to 2.75 (P value using paired t test ≤ 0.05). CONCLUSION: We do recommend the use of ESWT in treating AVN of bone whether of femoral head or other sites prior to the collapse of the articular surface. Further studies are needed to compare using two or more sessions as well as using four or six points for ESWT.

Management of Knee Flexion Contracture in a Child With 3MC Syndrome Using Taylor Spatial Frame.

3MC syndrome is a rare genetic disorder inherited through an autosomal recessive inheritance pattern caused by mutations in one of three genes: COLEC11, COLEC10, and MASP1. High-arched brows, ptosis, blepharophimosis, hypertelorism, cleft lip, cleft palate, developmental delay, hearing loss, abdominal wall defect, and urogenital and skeletal abnormalities are all characteristics. In previous reports, involvement of knee flexion contracture was not known to be one of the 3MC syndrome symptoms. The prevalence of 3MC syndrome is still unknown, and there have only been a few reports. We report the case of a four-year-old female with 3MC syndrome who was diagnosed with a confirmed mutation in the COLEC11 gene. We describe a method for decreasing knee flexion contracture in a reported patient that makes use of the Taylor spatial frame (TSF). Accepted results were observed because the patient has full extension, which must be maintained by the brace. According to our findings, the TSF was the safest, most accurate, stable fixator, and most efficient solution for treating knee flexion contracture, resulting in high patient and family satisfaction.

Tumoral Calcinosis Presentation in Operated Developmental Dysplasia of the Hip: A Case Report and Review of Literature.

Tumoral calcinosis has long been a disputed clinical-pathological subject. It has been characterized by the deposition of calcium salt and hydroxyapatite in different periarticular soft tissue regions. It is most commonly seen in adults, and rarely seen in children. In this report, we present the case of a six-year-old girl referred to our institution for one year with a history of left hip pain and swelling. The patient underwent an open reduction of left hip and acetabuloplasty for developmental dysplasia of the hip (DDH) at the age of two years. Systematic investigations were performed and showed that the patient had abnormal calcifications and large, ill-defined lesions with an irregular margin on the left hip extended to the left gluteal area with skin ulceration suggestive of primary tumor calcinosis. Medical therapy has started, and a follow-up appointment was given to her in a pediatric metabolic clinic. In addition, we present a brief literature review of the effect of medical and surgical treatments on tumor calcinosis.