Biomechanical and Clinical Correlates of Stance-Phase Knee Flexion in Persons With Spastic Cerebral Palsy
2016; 8 (1): 11-18
Caput valgum associated with developmental dysplasia of the hip: management by transphyseal screw fixation.
Journal of children's orthopaedics
2015; 9 (5): 371-379
Biomechanical and Clinical Correlates of Swing-Phase Knee Flexion in Individuals With Spastic Cerebral Palsy Who Walk With Flexed-Knee Gait
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
2015; 96 (3): 511-517
A late finding of some hips treated for developmental dysplasia of the hip (DDH) is a growth disturbance of the lateral proximal femoral physis, which results in caput valgum and possibly osteoarthritis. Current treatment options include complete epiphysiodesis of the proximal femoral physis or a corrective proximal femoral osteotomy. Alternatively, a transphyseal screw through the inferomedial proximal femoral physis that preserves superolateral growth might improve this deformity.This study evaluates the effect of such a transphyseal screw on both femoral and acetabular development in patients with caput valgum following open treatment of DDH. These patients were followed clinically and radiographically until skeletal maturity. Preoperative and postoperative radiographs were assessed, measuring the proximal femoral physeal orientation (PFPO), the head-shaft angle (HSA), Sharp's angle and the center edge angle of Wiberg (CE angle).Thirteen hips of 11 consecutive patients were followed prospectively. The age at the time of transphyseal screw placement was between 5 and 14 years. The mean improvement of the PFPO and HSA was 14° (p < 0.01) and 11° (p < 0.001), respectively. The mean improvement of Sharp's angle and CE angle was 4.7° (p < 0.01) and 5.8° (p < 0.02), respectively. Five patients underwent screw revision.A transphyseal screw across the proximal femoral physis improved the proximal femur and acetabular geometry.
View details for DOI 10.1007/s11832-015-0681-9
View details for PubMedID 26362171
Management of the knee in spastic diplegia: what is the dose?
Orthopedic clinics of North America
2010; 41 (4): 561-577
To identify clinical and biomechanical parameters that influence swing-phase knee flexion and contribute to stiff-knee gait in individuals with spastic cerebral palsy (CP) and flexed-knee gait.Retrospective analysis of clinical data and gait kinematics collected from 2010 to 2013.Motion and gait analysis laboratory at a children's hospital.Individuals with spastic CP (N=34; 20 boys, 14 girls; mean age ± SD, 10.1±4.1y [range, 5-20y]; Gross Motor Function Classification System I-III) who walked with flexed-knee gait ≥20° at initial contact and had no prior surgery were included; the more-involved limb was analyzed.Not applicable.The magnitude and timing of peak knee flexion (PKF) during swing were analyzed with respect to clinical data, including passive range of motion and Selective Control Assessment of the Lower Extremity, and biomechanical data, including joint kinematics and hamstring, rectus femoris, and gastrocnemius muscle-tendon length during gait.Data from participants demonstrated that achieving a higher magnitude of PKF during swing correlated with a higher maximum knee flexion velocity in swing (ρ=.582, P<0.001) and a longer maximum length of the rectus femoris (ρ=.491, P=.003). In contrast, attaining earlier timing of PKF during swing correlated with a higher knee flexion velocity at toe-off (ρ=-.576, P<.001), a longer maximum length of the gastrocnemius (ρ=-.355, P=.039), and a greater peak knee extension during single-limb support phase (ρ=-.354, P=.040).Results indicate that the magnitude and timing of PKF during swing were independent, and their biomechanical correlates differed, suggesting important treatment implications for both stiff-knee and flexed-knee gait.
View details for DOI 10.1016/j.apmr.2014.09.039
View details for Web of Science ID 000350265400019
View details for PubMedID 25450128
Sacral stress fractures in children.
American journal of orthopedics (Belle Mead, N.J.)
2009; 38 (5): 232-236
Infected Total Ankle Arthroplasty Following Routine Dental Procedure
FOOT & ANKLE INTERNATIONAL
2009; 30 (3): 252-257
Remodeling of birth fractures of the humeral diaphysis
JOURNAL OF PEDIATRIC ORTHOPAEDICS
2008; 28 (1): 10-13
This article discusses the sagittal gait patterns in children with spastic diplegia, with an emphasis on the knee, as well as the concept of the "dose" of surgery that is required to correct different gait pathologies. The authors list the various interventions in the order of their increasing dose. The concept of dose is useful in the consideration of the management of knee dysfunction.
View details for DOI 10.1016/j.ocl.2010.06.006
View details for PubMedID 20868885
Birth fractures of the humeral diaphysis are encountered at most pediatric medical centers and pediatric orthopaedic practices. The treatment strategy of these fractures is uniformly nonoperative. However, we have not found sufficient studies in the literature demonstrating the extent to which remodeling is possible and therefore how much deformity is acceptable in the treatment of these fractures.We reviewed the records of our institution's Orthopaedic Surgery Clinic and identified all children seen for birth fractures of the humerus from 2001 to 2005. The angulation and displacement at presentation and at follow-up were measured.All patients were treated nonoperatively, and most were managed by swaddling. In 9 patients with more than 4 months of radiographic follow-up, the mean initial angulation was 26 degrees in the coronal plane and 25 degrees in the sagittal plane. The mean angulation at final follow-up was 5 degrees in the coronal plane and 7 degrees in the sagittal plane. The maximum angulation at presentation was 66 degrees, which remodeled to 5 degrees at 7.3 months' follow-up.Our findings suggest that attempts to obtain an anatomical reduction or the use of more than the simplest immobilization methods are not necessary given the tremendous capacity for remodeling of these fractures in infants.
View details for Web of Science ID 000255766600003
View details for PubMedID 18157039