ABSTRACT
CASE: A young girl without pertinent medical history presented with a leg length discrepancy and an awkward gait disturbance. After a rapid growth spurt during the following year, other symptoms became obvious, she developed an inability to sit crossed legged, and her range of motion of the left hip decreased. Hip magnetic resonance imaging demonstrated a left unilateral fibrous band between the iliac wing and the greater trochanter. CONCLUSION: A fibrous band is a rare cause of leg length discrepancy and gait disturbance. The gait and hip movement improved after excision of the band.
Subject(s)
Femur , Gait , Female , Humans , Magnetic Resonance ImagingABSTRACT
BACKGROUND: Management of developmental dysplasia of the hip (DDH) with a Pavlik harness is a well-known treatment.Follow-up until skeletal maturity is recommended as long-term studies mention late sequelae.The purpose of this study was to determine whether such a follow-up is necessary in patients treated successfully under a strict protocol. METHODS: A retrospective review of a consecutive series of normal infants treated for DDH between January 1995 and July 2004 was undertaken.Only normal infants with frankly pathologic hips treated successfully with a Pavlik harness were included, and with a normal anteroposterior (AP) pelvis x-ray at the age of 2 years.All infants with any type of neurological disease, syndrome, other form of treatment for DDH, and failure of the Pavlik harness were excluded.At the last follow-up, a clinical examination and a standing AP pelvis x-ray were performed. RESULTS: A total of 109 hips in 83 children were available for review. The mean follow-up was of 10 years and 2 months. All 109 hips had a normal clinical examination and a normal AP pelvis x-ray: a mean center-edge angle (CEA) of 29.5 degrees, SD±4.1 degrees, a mean acetabular index (AI) of 1457±3.74 degrees, a mean Sharp's angle of 41.92±3.42 degrees, a Seringe-Severin score of IA, a normal teardrop figure, no signs of avascular necrosis, and Moses circles <2. CONCLUSION: This study strongly suggests that in a selected group of patients treated for DDH with a Pavlik harness, under a strict protocol, and a normal x-ray at 2 years of age, a long-term follow-up is not necessary. LEVEL OF EVIDENCE: Level III-therapeutic.
Subject(s)
Hip Dislocation, Congenital/therapy , Orthotic Devices , Aftercare , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Pelvis/diagnostic imaging , Radiography , Retrospective Studies , X-RaysABSTRACT
With advances in medical imaging over the past decades and with a multidisciplinary approach in bone tumour management, limb sparing procedures are more often feasible but come with new challenges. One of these is to deal with the remaining soft tissues, especially muscles, or bony parts and to restore continuity and a correct function. Synthetic ligaments have been used safely for several decades in various ligament reconstruction procedures with good results. We present a technique in which a synthetic ligament is used to augment or replace a joint capsule around a megaprosthesis. The joint is thus stabilized, and the remaining bony parts and muscles are attached to the synthetic material to restore continuity and allow better function of the spared limb.
Subject(s)
Arthroplasty, Replacement/methods , Artificial Organs , Bone Neoplasms/surgery , Ligaments , Plastic Surgery Procedures/methods , Biocompatible Materials , Equipment Design , Femoral Neoplasms/surgery , Humans , Humerus/surgery , Ligaments/surgery , Polyesters , Prostheses and ImplantsABSTRACT
Eighteen osteoporotic (Z-score at or below 2.5) nonambulatory children with cerebral palsy or a neuromuscular disorder received cyclic intravenous administration of pamidronate. One year after treatment, bone densitometry showed an improvement in all patients: a mean increase of 13% +/- 15% standard deviation (SD) (p < 10(-5)) on the global data, and a mean increase of 27% +/- 15% (p < 10(-5)) on the most significant area for each individual patient. Clinical improvement was found in all patients, with a decrease in pain on manipulation, and no new fractures. No major adverse effects were reported. Cyclic intravenous administration of pamidronate is a useful tool in the treatment of osteoporosis in these children.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Cerebral Palsy/complications , Diphosphonates/administration & dosage , Diphosphonates/therapeutic use , Neuromuscular Diseases/drug therapy , Neuromuscular Diseases/etiology , Osteoporosis/drug therapy , Osteoporosis/etiology , Adolescent , Child , Child, Preschool , Drug Administration Schedule , Female , Humans , Infusions, Intravenous , Male , Pain/etiology , Pamidronate , Prospective Studies , Treatment OutcomeABSTRACT
The aim of this study was to assess the intra- and interobserver reliability and reproducibility of goniometry and visual estimation of ankle joint range of motion measurements in children with spastic cerebral palsy. Forty-six ankles of 24 spastic cerebral palsy children were measured under a strict protocol. The global mean measurement error was 5 degrees (SD, 5 degrees) for intra- and interobserver measurements and 3 degrees (SD, 3 degrees) for goniometry versus visual estimation. Statistical analysis showed a high reliability for intra- and interobserver measurements (r>0.75), between visual estimation and goniometry (correlation coefficient, r>0.967; concordance coefficient, r>0.957). Both visual estimation and goniometry ankle range-of-motion measurements are reliable and reproducible in spastic cerebral palsy children if a strict but simple protocol is applied.
