Dislocation of hip in myelomeningocele. The McKay hip stabilization.

We reviewed the clinical and radiographic results of varus osteotomy of the proximal aspect of the femur and transfer of the adductor and external oblique muscles (the McKay procedure) in thirty-four children (sixty-six hips) who had an unstable hip secondary to a myelomeningocele at the middle or caudad lumbar level. the average age at the time of the operation was twenty months (range, seven to forty-two months). The average duration of follow-up was 10.9 years (range, 0.7 to 20.0 years). An open reduction was performed in ten hips. None of the children had had any previous operative treatment. The index operation helped to maintain the stability of thirty-seven of the fifty-one hips twenty-six children who remained neurologically stable: seventeen of nineteen hips that were at risk, two of three hips with acetabular dysplasia, fifteen of sixteen subluxated hips, one of three dislocated hips that had been previously reduced with a Pavlik harness, one of two dislocatable hips, and one of seven previously untreated dislocated hips. The index operation was not successful for one dislocated hip that had been treated with closed reduction and application of a spica cast. The operation was a success for eight of the fifteen hips in eight children who had a progressive loss of neurological function: three of five hips that were at risk, one hip with acetabular dysplasia, two of four subluxated hips, one of two that had been previously reduced with a Pavlik harness, and one dislocatable hip. Two dislocated hips redislocated. Initially the index operation was performed on all children who had a myelomeningocele at the third or fourth lumbar level. Recent data have shown that the hips in these children are not all at risk, and we now perform the operation only if there is documented instability of the hip.

Treatment of the chronically dislocated hip in adolescents with cerebral palsy with femoral head resection and subtrochanteric valgus osteotomy.

Femoral head resection with valgus subtrochanteric osteotomy was performed on six hips in five nonambulatory adolescent patients with painful, chronically dislocated hips due to spastic paralysis. This procedure was successful because it led to pain relief, ease of perineal care, and facility of seating. Complications, such as proximal migration of the remaining femur, recurrence of adduction deformity, hip stiffness, and excessive heterotopic bone formation, common to other procedures used for this condition, have not occurred.

Congenital subluxation of the knee--an anatomic dissection.

The knee of an infant born with congenital subluxation was dissected to delineate the pathology involved. The primary findings of importance included isolated fibrosis of the vastus intermedius muscle, absence of the gastrocnemius muscle, anterior displacement of the hamstrings and contracture of the anterior joint capsule. Comparison with previously described pathology is discussed.

Treatment of unicameral bone cysts by subtotal resection without grafts.

Twenty-one patients were treated operatively for unicameral bone cysts by subtotal resection without any form of bone graft, and all but two patients had satisfactory, prompt healing. The rate of recurrence was 9%. Five patients were noted to have humeral shortening prior to any surgery, and in them the changes in the epiphyseal cartilage were noted preoperatively. Pathological fractures were thought to be the cause of the shortening in those cases.