We present the 2 year results for the first 54 patients after Selective Dorsal Rhizotomy (SDR) delivered in Bristol, concentrating on change in Reimers' migration index. Eligible patients are selected at the SDR multidisciplinary meeting. Physiotherapy assessment is performed pre-operatively and at 6, 12 and 24 months post-surgery. Data collected includes GMFCS, Gross Motor Function Measure (GMFM) 88 and Modified Ashworth score for spasticity for major lower limb muscle groups, amongst other data. Pelvic radiographs are taken pre-operatively and at 2 years post-operatively. Reimers' migration index was measured using the hospital picture archiving and communication system (PACS). The mean age was 7.2 (3.9–17.5) at the time of surgery. Pre- and post-operative pelvic radiographs were available for 30 patients (60 hips). 57% (n=34) hips showed an increase in migration percentage (mean 5.4%, range 0.1–17.5%) and 43% (n=26) hips showed a decrease (mean 4.0%, range 0–15.5%). Overall no significant difference was found in Reimers' migration index at 2 year follow up (mean increase 1.3% (95% CI −0.3–3.0), p=0.12). There was an improvement in GMFCS category (by 1 grade) for 9 patients and a worsening for 1 patient at 2 year follow up. The Modified Ashworth score for spasticity improved in all patients. There was a mean improvement of 1.7 in the hip adductors and 2.4 in the ankle plantar flexors. There was a statistically significant improvement in the GMFM 88 D and E domains of 14.7 (95% CI 11.3–18.1), p<0.0001 and 11.4 (95% CI 7.4–15.7), p<0.0001 respectively. We found no evidence that SDR leads to worsening hip subluxation at 2 year follow up. All patients had improvement in lower limb spasticity. Overall there was a statistically significant improvement in function, as shown by GMFM 88 domains for standing, walking, running and jumping.
To determine whether hemiplegia causes abnormal torsion of the radius of the affected compared with the unaffected limb as demonstrated by MRI measurements, and to assess whether this correlates with the passive range of movement as measured clinically. 27 patients who fit the inclusion criteria were recruited from an existing database of hemiplegic patients into our prospective cohort study. A clinical assessment was made of each subject to determine the range of active and passive upper limb movements. A functional assessment of the children's upper limbs was made using the validated House score. Subsequent MRI scans of both upper limbs were then performed. A single radiologist (blinded as to the affected limb) then measured the torsional profiles of both radii using a method validated by Bindra et al.Purpose of study
Methods
The purpose was to review the results of latissimus dorsi and teres major transfer in a group of children with shoulder disability due to brachiaI plexus palsy. Whilst their incidence has steadily declined, obstetric brachial plexus palsies are a continuing problem in paediatric orthopaedic practice. Lesions of the upper plexus (C4, C5, C6) are characterised by a loss of abduction and external rotation at the shoulder. The L’Episcopo procedure and its variants aim to address this by transfer of the latissimus dorsi and teres major. There have been conflicting reports in the literature as to the functional benefit of such procedures. A retrospective review of such procedures performed by one surgeon at a paediatric orthopaedic tertiary referral centre in New Zealand. Patients were assessed pre- and post-operatively in terms of range of movement and function. The Mallet scoring system was also used. Eight patients were examined by an independent observer up to 120 months following surgery (average 52 months). In most cases significant increases in range of movement, function and Mallet scores were noted. With regard to complications, where the paresis is severe to the extent that it is causing shoulder subluxation, tendon transfer surgery is contra-indicated. The L’Episcopo procedure was largely successful in restoring improved function to the shoulder girdle in this group of patients.
