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Surgical treatment of myelomeningocele—Editorial
766
INTERNATIONAL
Four children were seen because of femoral neck fractures, all sustained in traiIic accidents. Two of them aged I4 and I5 years, were treated by internal fixation with a Smith-Petersen nail. The late results were poor, because of avascular necrosis of the femoral head. The 2 others, years, were treated with adhesive The
final results
were favorable.
cludes
that
proach
is to be preferred
unstable does The
in these
fractures,
not lead
the
author
con-
conservative
ap-
or if conservative
PEHTHES
is indicated.
nails is not considered
TREAT~IENT
Arch.
all
with
Chir.
Need.
Legg-Calve-Perthes
rest with plaster
extension
of the involved
tion using
a Thomas
of bed rest was omitted.
cnse in 34 patients.
Weight
until complete lasted
leg until
by mobiliza-
If no pain
occurred
This
bearing
was the
was not alThe
18 to 48 months.
In every
head index according
to Eyre-
Bi-ock was measured
(height
of epiphysis
divided
by its width)
and compared
with
the index
normal
of
age.
A
child
erate
the
often
in girls Bad
is dependent epiphysial The
a mod40 per
Bad results were seen more
increased
on the
in a result
and a bad result
and in patients results
degree
with
both
with age.
hips inPrognosis
of deviation
of the
axis from normal.
end results in one third,
cases.-E.
good
an index of 70 per cent or more,
cent or less of normal.
erate
same
40 to 70 per cent
volved.
the
of be-1
cure was demonstrated.
from
the femoral
of
consisted
the period
treatment
3 to 10 years
This was followed splint.
1967.
disease
The treatment
the pain subsided.
SPLINT. T.
19:275,
of 55 children,
hip were reviewed.
showed
or
IN LEGG-CAL&-
DISEASE USING A THOMAS
The case histories
patient
management
operation
as the use of thin screws
OF
Bleeker.
lowed
Only in
Kale.
RESULTS
W.
The
over operation.
use of Smith-Petersen
THE
old,
cases
to success,
to be as satisfactory wires.-E.
aged 3 and 5 tape extension.
Kale.
were
good in one third,
and bad
in one third
modof the
ABSTRA(JTS OF PEDIATRIC
NERVOUS
SURGERY
SYSTEM
DIASTEMATOMYELIA AS A CAUSE OF NEUROLOGICAL DISTURBANCES IN CHILDREN: DIAGNOSIS AND TREATMENT. H. D. Kunft and K. Vessal. Z. I;. Chir. 6:4-10, 1968. The rare case of a cleft in the spinal canal and its contents is reported. The lower part of the spinal cord is usually affected. Symptoms suspicious of this diagnosis include delayed walking, limping, continuous bed wetting, and bad posture of the child. In the presence of neurologic signs operation is advised as early as possible to remove the spur or septum. One personal case is noted. -S. Hofmann and H. E&stein. SURGICAL TREAThlENT OF MYELO;ZIENINGOCELEEDITORIAL. Donald D. Matson. Pediatrics 42: 225-227 (August) 1968. “Whether to operate” and “when to operate” are questions to be answered in every infant born with a nonepithelialized form of spina bifida cystica. In the Neurosurgical Clinic of Children’s Hospital of Boston, when examination on the first day of life confirms total absence of neurologic function below the upper lumbar levels, custodial care only is recommended. If there is no paralysis or there is some partial motor function suggesting that independent ambulation and a reasonably normal upper urinary tract will be possible, the myelomeningocele is repaired as soon as practical. The optimum time for closure is considered to be the first 24 hours of life. If technical or practical circumstances make this impossible, surgery should be deferred no longer than required for the correction of these problems. The best care of these infants involves conscientious and continuous urologic, orthopedic, ancl neurosurgical rehabilitation. This editorial asks every physician seeing such infants to give the neurosurgeon the opportunity of evaluating these infants in the first 24 hours of life. It stresses the importance of decisions based on mature, unhurried, discussions between physician, surgeon, and parents.-W. K. Sieber.
INTERNATIONAL
Four children were seen because of femoral neck fractures, all sustained in traiIic accidents. Two of them aged I4 and I5 years, were treated by internal fixation with a Smith-Petersen nail. The late results were poor, because of avascular necrosis of the femoral head. The 2 others, years, were treated with adhesive The
final results
were favorable.
cludes
that
proach
is to be preferred
unstable does The
in these
fractures,
not lead
the
author
con-
conservative
ap-
or if conservative
PEHTHES
is indicated.
nails is not considered
TREAT~IENT
Arch.
all
with
Chir.
Need.
Legg-Calve-Perthes
rest with plaster
extension
of the involved
tion using
a Thomas
of bed rest was omitted.
cnse in 34 patients.
Weight
until complete lasted
leg until
by mobiliza-
If no pain
occurred
This
bearing
was the
was not alThe
18 to 48 months.
In every
head index according
to Eyre-
Bi-ock was measured
(height
of epiphysis
divided
by its width)
and compared
with
the index
normal
of
age.
A
child
erate
the
often
in girls Bad
is dependent epiphysial The
a mod40 per
Bad results were seen more
increased
on the
in a result
and a bad result
and in patients results
degree
with
both
with age.
hips inPrognosis
of deviation
of the
axis from normal.
end results in one third,
cases.-E.
good
an index of 70 per cent or more,
cent or less of normal.
erate
same
40 to 70 per cent
volved.
the
of be-1
cure was demonstrated.
from
the femoral
of
consisted
the period
treatment
3 to 10 years
This was followed splint.
1967.
disease
The treatment
the pain subsided.
SPLINT. T.
19:275,
of 55 children,
hip were reviewed.
showed
or
IN LEGG-CAL&-
DISEASE USING A THOMAS
The case histories
patient
management
operation
as the use of thin screws
OF
Bleeker.
lowed
Only in
Kale.
RESULTS
W.
The
over operation.
use of Smith-Petersen
THE
old,
cases
to success,
to be as satisfactory wires.-E.
aged 3 and 5 tape extension.
Kale.
were
good in one third,
and bad
in one third
modof the
ABSTRA(JTS OF PEDIATRIC
NERVOUS
SURGERY
SYSTEM
DIASTEMATOMYELIA AS A CAUSE OF NEUROLOGICAL DISTURBANCES IN CHILDREN: DIAGNOSIS AND TREATMENT. H. D. Kunft and K. Vessal. Z. I;. Chir. 6:4-10, 1968. The rare case of a cleft in the spinal canal and its contents is reported. The lower part of the spinal cord is usually affected. Symptoms suspicious of this diagnosis include delayed walking, limping, continuous bed wetting, and bad posture of the child. In the presence of neurologic signs operation is advised as early as possible to remove the spur or septum. One personal case is noted. -S. Hofmann and H. E&stein. SURGICAL TREAThlENT OF MYELO;ZIENINGOCELEEDITORIAL. Donald D. Matson. Pediatrics 42: 225-227 (August) 1968. “Whether to operate” and “when to operate” are questions to be answered in every infant born with a nonepithelialized form of spina bifida cystica. In the Neurosurgical Clinic of Children’s Hospital of Boston, when examination on the first day of life confirms total absence of neurologic function below the upper lumbar levels, custodial care only is recommended. If there is no paralysis or there is some partial motor function suggesting that independent ambulation and a reasonably normal upper urinary tract will be possible, the myelomeningocele is repaired as soon as practical. The optimum time for closure is considered to be the first 24 hours of life. If technical or practical circumstances make this impossible, surgery should be deferred no longer than required for the correction of these problems. The best care of these infants involves conscientious and continuous urologic, orthopedic, ancl neurosurgical rehabilitation. This editorial asks every physician seeing such infants to give the neurosurgeon the opportunity of evaluating these infants in the first 24 hours of life. It stresses the importance of decisions based on mature, unhurried, discussions between physician, surgeon, and parents.-W. K. Sieber.