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Ilio-psoas muscle transfer in the treatment of myelomeningocele patients with paralytic hip deformities
566
ABSTRACTS
tively. One patient had an ileus and two patients had a bedsore. Seventy-four patients went to a solid fusion with healing of the tuberculous lesion. Sixteen patients had a stable nonunion with healing of the disease. Ten patients had an unstable nonunion, requiring further treatment. From a pure pressure type of paraplegia, prognosis for recovery is excellent. The feeling was that the surgical approach sped the course and returned the patients to a functioning existence more rapidly with less complications-Anthony H. Alter
Ilio-psoas Muscle Transfer in the Treatment of Myelomeningocele Patients With Paralytic Hip Deformities. A. A. Freehafer. J. C. Vessely, and R. P. Mack. J Bone Joint Surg 54:Al715-1729 (December), 1972. Fifty-two Sharrard-type iliopsoas transfers were performed in 28 patients with myelomeningocele. The preferred time of surgery was I8 mo to 3 yr, to allow remodeling as an active sequel to the procedure. The goals of the procedure were to correct the deformity, provide a stable reduction of the hip, maintain a good range of motion, and improve the abduction and extension. This was accomplished in all but tive patients. The patients continued to improve subsequent to the procedure in all but two cases. Changes in the neck shaft femoral angle were seen if the patient was less than 3 yr of age. Five procedures shelf acetabuloplasty had an associated performed for shallow acetabula. Two patients had a concomitant varus and derotation osteotomy and the third went on to develop an intertrochanteric fracture, which was used as a corrective osteotomy treatment. Complications included loss of hip motion in three patients, aseptic necrosis secondary to a complicating hip fracture after removal of cast in one patient, recurrent dislocation of the hip in one patient, persistent dislocation in another patient “in whom the procedure was probably not indicated,” one wound infection and other complicating fractures. The feeling was that improvement in function and physical findings occurred in 45 of the hips operated upon, and that this is a worthwhile procedure to do on patients with myelomeningocele who are potentially ambulatory.-Anthony
H. Alter
Surgical Management of Spinal Deformities in Spina Bifida. K. Sriram, W. P. Bobechko and J. E. Hull. J Bone Joint Surg 54:B666-676 (November), 1972.
Thirty-three patients were treated in a period of I I yr for spinal deformities related to spina bifida with myelomeningocele. Many had additional spinal abnormalities contributing to the deformity. These deformities were classified as to their appearance and severity of an associated scoliosis. All patients eventually underwent surgery, many after failures of conservative care for their spinal sumptoms, including fatigue, pressure sores, and problems with placement of ilioconduit stomas. Varying surgeries, including halofemoral traction, posterior spine fusions with and without Harrington instrumentation, spinal osteotomy, rib resections, and one case of anterior spine fusion, were performed for a total of 39 operations. Of the 33 patients, 16 had good results, eight fair, and nine poor results. Analysis of the failures led to the following conclusions: (I) Whenever there is extensive skin scarring or a need for resection of the residual myelomeningocele sac, it is safer to do the fusion in two stages. (2) Excision of the pedicles on either side will allow skin closure without tension. (3) The posterior osteotomy of the kyphotic older child who has a partial neurologic lesion should not be done because of risk of increasing the neurologic lesion. (4) There is a high incidence of pseudarthrosis in long fusions, associated with technical problems in placement of the Harrington rods. This paper served as a baseline for future anterior spinal surgery that is currently being studied and will be presented.-Anrhony H. Alter
Slipped Femoral Reduction of Acutely Epiphysis. 8. H. Casey. H. W. Hamilton and W. P. Bobechko. J Bone Joint Surg 54:B607614(November), 1972. Thirty-four patients with 35 acute slipped capital femoral epiphyses were studied. Thirtytwo patients had a reasonable history of trauma preceding this injury. A review of the various techniques of treatments by various physicians found that skin traction with a medial rotation strap, followed 3-4 days later by internal fixation without further manipulation, achieved the best clinical results. There were five cases of avascular necrosis of the femoral head, felt to be related to a more aggressive treatment program. -Anthony H. Alter Calcaneal Osteotomy for Valgus and Varus Deformities of the Foot. M. Silver, S. D. Simon, and H. M. Litchmnn. Int Surg 5824-30 (January), 1973.
ABSTRACTS
tively. One patient had an ileus and two patients had a bedsore. Seventy-four patients went to a solid fusion with healing of the tuberculous lesion. Sixteen patients had a stable nonunion with healing of the disease. Ten patients had an unstable nonunion, requiring further treatment. From a pure pressure type of paraplegia, prognosis for recovery is excellent. The feeling was that the surgical approach sped the course and returned the patients to a functioning existence more rapidly with less complications-Anthony H. Alter
Ilio-psoas Muscle Transfer in the Treatment of Myelomeningocele Patients With Paralytic Hip Deformities. A. A. Freehafer. J. C. Vessely, and R. P. Mack. J Bone Joint Surg 54:Al715-1729 (December), 1972. Fifty-two Sharrard-type iliopsoas transfers were performed in 28 patients with myelomeningocele. The preferred time of surgery was I8 mo to 3 yr, to allow remodeling as an active sequel to the procedure. The goals of the procedure were to correct the deformity, provide a stable reduction of the hip, maintain a good range of motion, and improve the abduction and extension. This was accomplished in all but tive patients. The patients continued to improve subsequent to the procedure in all but two cases. Changes in the neck shaft femoral angle were seen if the patient was less than 3 yr of age. Five procedures shelf acetabuloplasty had an associated performed for shallow acetabula. Two patients had a concomitant varus and derotation osteotomy and the third went on to develop an intertrochanteric fracture, which was used as a corrective osteotomy treatment. Complications included loss of hip motion in three patients, aseptic necrosis secondary to a complicating hip fracture after removal of cast in one patient, recurrent dislocation of the hip in one patient, persistent dislocation in another patient “in whom the procedure was probably not indicated,” one wound infection and other complicating fractures. The feeling was that improvement in function and physical findings occurred in 45 of the hips operated upon, and that this is a worthwhile procedure to do on patients with myelomeningocele who are potentially ambulatory.-Anthony
H. Alter
Surgical Management of Spinal Deformities in Spina Bifida. K. Sriram, W. P. Bobechko and J. E. Hull. J Bone Joint Surg 54:B666-676 (November), 1972.
Thirty-three patients were treated in a period of I I yr for spinal deformities related to spina bifida with myelomeningocele. Many had additional spinal abnormalities contributing to the deformity. These deformities were classified as to their appearance and severity of an associated scoliosis. All patients eventually underwent surgery, many after failures of conservative care for their spinal sumptoms, including fatigue, pressure sores, and problems with placement of ilioconduit stomas. Varying surgeries, including halofemoral traction, posterior spine fusions with and without Harrington instrumentation, spinal osteotomy, rib resections, and one case of anterior spine fusion, were performed for a total of 39 operations. Of the 33 patients, 16 had good results, eight fair, and nine poor results. Analysis of the failures led to the following conclusions: (I) Whenever there is extensive skin scarring or a need for resection of the residual myelomeningocele sac, it is safer to do the fusion in two stages. (2) Excision of the pedicles on either side will allow skin closure without tension. (3) The posterior osteotomy of the kyphotic older child who has a partial neurologic lesion should not be done because of risk of increasing the neurologic lesion. (4) There is a high incidence of pseudarthrosis in long fusions, associated with technical problems in placement of the Harrington rods. This paper served as a baseline for future anterior spinal surgery that is currently being studied and will be presented.-Anrhony H. Alter
Slipped Femoral Reduction of Acutely Epiphysis. 8. H. Casey. H. W. Hamilton and W. P. Bobechko. J Bone Joint Surg 54:B607614(November), 1972. Thirty-four patients with 35 acute slipped capital femoral epiphyses were studied. Thirtytwo patients had a reasonable history of trauma preceding this injury. A review of the various techniques of treatments by various physicians found that skin traction with a medial rotation strap, followed 3-4 days later by internal fixation without further manipulation, achieved the best clinical results. There were five cases of avascular necrosis of the femoral head, felt to be related to a more aggressive treatment program. -Anthony H. Alter Calcaneal Osteotomy for Valgus and Varus Deformities of the Foot. M. Silver, S. D. Simon, and H. M. Litchmnn. Int Surg 5824-30 (January), 1973.