Journal of pediatric orthopedics
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Correcting multiplanar lower-limb pediatric deformities requires complex and, in many cases, staged procedures. The Taylor-Spatial Frame (TSF) is a sophisticated external fixator system that can be used to treat simple to complex multiplanar and multiapical skeletal deformities. We describe its use in 53 children during the last 7 years in a variety of pathologies and demonstrate its ease of use and versatility. ⋯ We demonstrate its ease of use for both surgeon and patient and its versatility in a variety of pathologies. The advantages of the TSF system are many. It is a simple frame construct, and application is easy. The plan and execution are structured with precise end points; it is a single-stage correction and thus avoids frame modifications. Any residual deformity can be further corrected by use of the same frame. We conclude that the TSF is an effective and efficient way to correct a wide variety of simple and complex often obstinate pediatric limb deformities.
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Pediatric patients with congenital thoracic scoliosis often have restrictive lung disease and low body weight for age. In other patients with respiratory disorders, the work of breathing can increase basal metabolic demands and predispose patients to cachexia. The primary study aim was to determine if severity of restrictive lung disease, as measured by pulmonary spirometry, correlates to decreased body mass index (BMI) in patients with congenital thoracic scoliosis. A secondary study aim was to determine what patient factors and radiographic measures correlate to low BMI. ⋯ Prognostic case-control study, level III.
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Hinge abduction is widely accepted as a poor prognostic factor in Legg-Calvé-Perthes disease (LCPD), whereas the exact definition of hinge abduction remains ill defined. The purpose of this diagnostic study was to refine the definition of hinge abduction in LCPD using conventional hip arthrography under general anesthesia. ⋯ Level II (diagnostic study, development of diagnostic criteria on the basis of consecutive patients).
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Controlled Clinical Trial
The impact of intrathecal baclofen on the natural history of scoliosis in cerebral palsy.
Intrathecal baclofen (ITB) is an effective treatment of spasticity in patients with cerebral palsy. However, several recent reports have raised concerns that the treatment may be associated with a rapid progression of scoliosis. The objective of this study was to further examine the effect of ITB treatment on the progression of scoliosis in patients with cerebral palsy. ⋯ Level III.
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To better understand anatomical and functional outcomes of coxa vara in chondrodysplasia according to the initial presenting hip morphology, disease type, and impact of surgery. ⋯ Coxa vara with physeal and epiphyseal involvement and severe impairment of the articular cartilage has a poor prognosis even after reconstructive surgery. In coxa vara with an abnormal physis, there were numerous postsurgical recurrences of the deformity during growth if the physis was not stabilized at the time of valgus osteotomy. In these cases, we should delay osteotomy until an HEA greater than 60 degrees. Coxa vara in which only the metaphysis of the femoral neck is involved, the deformity is milder and often requires no treatment. Indications for surgery in this group are increasing coxa vara, Trendelenburg gait, or an HEA greater than 60 degrees.