Journal of pediatric orthopedics. Part B
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Neuromuscular scoliosis concerns a wide variety of disorders, all with a different approach to surgical intervention. The impact of these disorders on a patient is discussed in terms of pulmonary, cardiac, bowel and bladder function and complications in the perioperative and postoperative period such as gastric ulcers, pathologic fractures, wound healing, and nutrition is described. ⋯ Items on preoperative clinical and radiological examination are provided, as well as points of special attention in perioperative care. Early detection, decision-making and intervention makes it possible to correct and stabilize the spine in these children with a short stay in hospital and a quick recovery.
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Early radiographic screening and/or referral to a clinical specialist are often used to distinguish between physiologic bow leg deformity and infantile tibia vara disease in young children. These practices are a consequence of the clinician's inability (based upon the clinical examination) to distinguish between the deformities associated with physiologic and pathologic bow legs. Because the great majority of these children have physiologic bowing, routine radiographic screening and referral are not cost effective and expose children to unnecessary radiation. ⋯ We conclude that the 'cover up' test is an effective screening tool for the assessment of bow legs in children between 1 and 3 years of age. Children with a negative 'cover up' test do not require radiographic evaluation and should be followed clinically for resolution of the bowing. Children with a positive 'cover up' test should have radiographic evaluation of the lower extremities or be referred to a specialist for further evaluation and treatment.