Aims. The Uppföljningsprogram för cerebral pares (CPUP) Hip Score distinguishes between children with
Aims. The purpose of this study was to compare the prevalence of hip displacement and dislocation in a total population of children with
Aims. Hip displacement, common in patients with
Aims. To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic
Aims. A flexed knee gait is common in patients with bilateral spastic
cerebral palsy and occurs with increased age. There is a risk for
the recurrence of a flexed knee gait when treated in childhood,
and the aim of this study was to investigate whether multilevel
procedures might also be undertaken in adulthood. Patients and Methods. At a mean of 22.9 months (standard deviation 12.9), after single
event multi level surgery, 3D gait analysis was undertaken pre-
and post-operatively for 37 adult patients with bilateral cerebral
palsy and a fixed knee gait. Results. There was a significant improvement of indices and clinical and
kinematic parameters including extension of the hip and knee, reduction
of knee flexion at initial contact, reduction of minimum and mean
knee flexion in the stance phase of gait, improved range of movement
of the knee and a reduction of mean flexion of the hip in the stance phase.
Genu recurvatum occurred in two patients (n = 3 legs, 4%) and an
increase of pelvic tilt (>
5°) was found in 12 patients (n = 23
legs, 31%). Conclusion. Adult patients with bilateral
In 1994 a
Aims. Guided growth has been used to treat coxa valga for
We reviewed the long-term radiological outcome,
complications and revision operations in 19 children with quadriplegic
cerebral palsy and hip dysplasia who underwent combined peri-iliac
osteotomy and femoral varus derotation osteotomy. They had a mean
age of 7.5 years (1.6 to 10.9) and comprised 22 hip dislocations
and subluxations. We also studied the outcome for the contralateral
hip. At a mean follow-up of 11.7 years (10 to 15.1) the Melbourne
cerebral palsy (CP) hip classification was grade 2 in 16 hips, grade
3 in five, and grade 5 in one. There were five complications seen
in four hips (21%, four patients), including one dislocation, one
subluxation, one coxa vara with adduction deformity, one subtrochanteric
fracture and one infection. A recurrent soft-tissue contracture occurred
in five hips and ten required revision surgery. In pre-adolescent children with quadriplegic
We describe 13 patients with
Although equinus gait is the most common abnormality
in children with spastic
Aims. The migration percentage (MP) is one criterion used for surgery in dislocated or displaced hips in children with
There is much debate about the nature and extent of deformities in the proximal femur in children with
In 1994, a register for
We have tested the reliability of a recently reported classification system of hip morphology in adolescents with
In
1. Correction of equinus deformity in
We studied prospectively the impact of a hip surveillance clinic on the management of spastic hip disease in children with
We reviewed the evidence for hip surveillance in children with
Pelvic obliquity is a common finding in adolescents
with
1. Thirteen years of experience in charge of treatment in a Residential School for
This study compares the initial outcomes of minimally invasive techniques for single-event multi-level surgery with conventional single-event multi-level surgery. The minimally invasive techniques included derotation osteotomies using closed corticotomy and fixation with titanium elastic nails and percutaneous lengthening of muscles where possible. A prospective cohort study of two matched groups was undertaken. Ten children with diplegic
We performed rotational acetabular osteotomy in order to treat dysplasia of the hip in five ambulatory adults with
1. Ten children with scoliosis and
In developed countries, children with
We carried out a morphometric analysis of acetabular dysplasia in patients with
The aims of this study were to report functional
outcomes of salvage procedures for patients with
The results of a functional, clinical and radiological study of 30 children (60 hips) with whole-body
Hip displacement, defined in this study as a
migration percentage (MP) of more than 40%, is a common, debilitating complication
of
1. Analysis of the static and dynamic conditions in spastic
When
We describe a patient with
To determine the natural history of dislocation of the hip in
We carried out a morphometric analysis of the acetabulum following Dega osteotomy in patients with
In patients with severe quadriplegic
Operative treatment was performed in nine patients with cervical spondylotic myelopathy complicating athetoid
A percutaneous supramalleolar osteotomy with multiple drill holes and closed osteoclasis was used to correct rotational deformities of the tibia in patients with
Between July 2000 and April 2004, 19 patients with bilateral spastic
We report the results of Vulpius transverse gastrocsoleus
recession for equinus gait in 26 children with
Aims. Single event multilevel surgery (SEMLS) has been shown to improve
gait in children with
Transepiphyseal separation of the neck of the femur following grand mal seizures is described in two children with
We reviewed the outcome in 24 children with bilateral spastic
We have reviewed the cervical spine radiographs of 180 patients with athetoid
Five cases of Kienbock's disease occurring in a group of fifty-three adults with
We have considered the indications for and results of transplanting pronator teres to extensor carpi radialis brevis in
In order to treat painful subluxation or dislocation secondary to
Our aim was to evaluate the effect of adding inhibitory casting to the treatment of young children with
1. In children with
1. In a prospective study of sixty patients with
We have studied the natural history of spontaneous dislocation of the hip in
We assessed the medium-term outcome of three methods of isolated calf lengthening in
A total of 47 non-walking patients (52 hips) with severe
We treated 22 children (28 limbs) with diplegic
The clinical and radiological state of the hips of a group of children with
Spasm or contracture of the gastrocnemius muscle is predominantly responsible for the equinus deformity of the foot in
Our aim in this retrospective study was to analyse the value of serial corrective casts in the management of toe-walking in children aged less than six years with
Transfer of flexor carpi ulnaris combined with selective release of the flexor pronator origin was undertaken in 35 patients with hemiplegic
We report the results of a new surgical procedure for spastic equinovarus deformity due to
1 . A ten-year study of fifty-four operations for transplantation of the hamstring muscles in thirty-one spastic patients has been made. 2. Twenty-one patients were improved after operation, six were not improved, and in four the duration of follow-up was too short for proper assessment. One patient died from other causes. 3. Greatest benefit was not obtained until one year after operation. 4. The results varied considerably in different grades of spastic patient. Important factors affecting the results were age, sex, personality, balance and function of arm and hip. Hand and major hip operations should be carried out before hamstring transplantation. 5. The objectives of operation are discussed. These were most consistently achieved in older, more ambitious or more responsible males with good balance and with good arm and hip function. 6. Factors which were of less direct importance were mental capacity, minor degrees of limb length inequality, and foot deformities. 7. Operative correction of foot deformities should not be done before hamstring transplantation. 8. Serial plaster correction of the knee flexion deformity before operation is preferred to division of the patellar retinacula. 9. Transplantation of the hamstrings to the patella in spastics is under trial.
Aims. The purpose of this study was to evaluate the long-term outcome
of adolescents with
The painful subluxed or dislocated hip in adults
with
Avulsion of the distal pole of the patella in spastic children with a flexed knee gait may upset the equilibrium of the knee and cause deterioration in walking. We emphasise the clinical features, discuss the mechanism and outline the principles of treatment.
Clinical assessment of equinus in children before and after operation was made over a twenty-year period (1958-1978), and three groups were defined. Forty-three muscles (Group I) had abnormal shortening without spasticity and the deformity progressed steadily despite immediate improvement after operation; this was considered to be the result of a lack of muscle growth during bone growth. Forty-one muscles (Group II) had both shortening and spasticity with an imbalance which might be unchanged after operation, or reversed or improved. Fourteen muscles (Group III) had spasticity only and progression was unpredictable and could not be defined. Improvement in gait was regularly observed in Group I in the early years after operation. In Groups II and III the results were variable. These results did not depend on surgical technique but on differences in pathophysiology.
We studied the prevalence of severe crouch gait
over a 15-year period in a defined population of children with spastic
diplegia and Gross Motor Function Classification System levels II
and III, to determine if there had been a decrease following changes
to the management of equinus gait. These changes were replacing
observational with three-dimensional gait analysis, replacing single
level with multilevel surgery, and replacing gastrocsoleus lengthening
with gastrocnemius recession. Of 464 children and adolescents with
spastic diplegia who underwent three-dimensional gait analysis,
27 had severe crouch gait. Seventeen of these had been managed by
isolated lengthening of the gastrocsoleus. Following changes in
the management of equinus gait, the prevalence of severe crouch
gait decreased from 25% and stabilised at a significantly lower
rate, fluctuating between 0% and 4% annually (p <
0.001). . We conclude that severe crouch gait in this population was precipitated
by isolated lengthening of the gastrocsoleus. These findings may
be relevant to other surgical populations, as severe crouch gait
may be a useful way to monitor the quality of the surgical management
of abnormal gait in children with
We investigated the incidence and risk factors
for the development of avascular necrosis (AVN) of the femoral head in
the course of treatment of children with
Aims. To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). Methods. We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. Results. A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with
Degenerative problems of the hip in patients
with childhood and adult onset neuromuscular disorders can be challenging
to treat. Many orthopaedic surgeons are reluctant to recommend total
hip replacement (THR) for patients with underlying neuromuscular
disorders due to the perceived increased risks of dislocation, implant loosening,
and lack of information about the functional outcomes and potential
benefits of these procedures in these patients. Modular femoral
components and alternative bearings which facilitate the use of
large femoral heads, constrained acetabular components and perhaps
more importantly, a better understanding about the complications
and outcomes of THR in the patient with neuromuscular disorders,
make this option viable. This paper will review the current literature
and our experience with THR in the more frequently encountered neuromuscular
disorders. Cite this article:
Aims. Single-event multilevel surgery (SEMLS) has been used as an effective
intervention in children with bilateral spastic
Proximal femoral resection (PFR) is a proven
pain-relieving procedure for the management of patients with severe cerebral
palsy and a painful displaced hip. Previous authors have recommended
post-operative traction or immobilisation to prevent a recurrence
of pain due to proximal migration of the femoral stump. We present
a series of 79 PFRs in 63 patients, age 14.7 years (10 to 26; 35
male, 28 female), none of whom had post-operative traction or immobilisation. A total of 71 hips (89.6%) were reported to be pain free or to
have mild pain following surgery. Four children underwent further
resection for persistent pain; of these, three had successful resolution
of pain and one had no benefit. A total of 16 hips (20.2%) showed
radiographic evidence of heterotopic ossification, all of which
had formed within one year of surgery. Four patients had a wound
infection, one of which needed debridement; all recovered fully.
A total of 59 patients (94%) reported improvements in seating and
hygiene. The results are as good as or better than the historical results
of using traction or immobilisation. We recommend that following
PFR, children can be managed without traction or immobilisation,
and can be discharged earlier and with fewer complications. However,
care should be taken with severely dystonic patients, in whom more
extensive femoral resection should be considered in combination
with management of the increased tone. Cite this article:
Lengthening of the conjoined tendon of the gastrocnemius
aponeurosis and soleus fascia is frequently used in the treatment
of equinus deformities in children and adults. The Vulpius procedure
as described in most orthopaedic texts is a division of the conjoined
tendon in the shape of an inverted V. However, transverse division
was also described by Vulpius and Stoffel, and has been reported
in some clinical studies. We studied the anatomy and biomechanics of transverse division
of the conjoined tendon in 12 human cadavers (24 legs). Transverse
division of the conjoined tendon resulted in predictable, controlled
lengthening of the gastrocsoleus muscle-tendon unit. The lengthening
achieved was dependent both on the level of the cut in the conjoined
tendon and division of the midline raphé. Division at a proximal
level resulted in a mean lengthening of 15.2 mm ( Cite this article:
Neurological conditions affecting the hip pose a considerable challenge in replacement surgery since poor and imbalanced muscle tone predisposes to dislocation and loosening. Consequently, total hip replacement (THR) is rarely performed in such patients. In a systematic review of the literature concerning THR in neurological conditions, we found only 13 studies which described the outcome. We have reviewed the evidence and discussed the technical challenges of this procedure in patients with
Aims. We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores. Patients and Methods. We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated
The recognition of hips at risk of displacement
in children with
We reviewed retrospectively 94 patients who had undergone soft-tissue release to correct flexion contracture of the knee to determine the incidence of postoperative hypertension. The cause of contracture in most patients was
Spasm or contracture of gastrocnemius causes an equinus deformity of the ankle in both
Of 23 children (35 feet) with
In 2017, the British Society for Children’s Orthopaedic Surgery engaged the profession and all relevant stakeholders in two formal research prioritization processes. In this editorial, we describe the impact of this prioritization on funding, and how research in children’s orthopaedics, which was until very recently a largely unfunded and under-investigated area, is now flourishing. Establishing research priorities was a crucial step in this process. Cite this article:
1. The nature of paralytic deformity arising in poliomyelitis,
A method of triple arthrodesis is described which involves inlay of the subtalar and midtarsal joints. It is applicable to the undeformed and valgus foot as is encountered in poliomyelitis, spasmodic flat foot,
We describe a technique of femoral derotation osteotomy performed according to the Ilizarov principles of percutaneous corticotomy and fixation with a frame. We performed 24 femoral osteotomies in 16 patients, four with
We report the incidence of and risk factors for
complications after scoliosis surgery in patients with Duchenne muscular
dystrophy (DMD) and compare them with those of other neuromuscular
conditions. We identified 110 (64 males, 46 females) consecutive patients
with a neuromuscular disorder who underwent correction of the scoliosis
at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up.
We recorded demographic and peri-operative data, including complications
and re-operations. There were 60 patients with
We report the case of a child with
1. Talipes equinovarus is a specific type of club foot which has a genetic basis. Its occurrence along with certain neurological disorders has been noted. 2. An investigation of its incidence in 1,447 mental defectives, excluding those with
Traction injury to the sciatic nerve can occur during hamstring lengthening. The aim of this study was to monitor the influence of hamstring lengthening on conduction in the sciatic nerve using evoked electromyography (EMG). Ten children with spastic
There were 22 patients with
Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs. A PROSPERO-registered systematic literature review was performed following PRISMA guidelines. All relevant studies published until January 2023 were identified. Individual outcomes and outcome measurement tools were extracted verbatim. The measurement tools were assessed for reliability and validity, and all outcomes were grouped according to the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT) filters.Aims
Methods