Surgical treatment of myelomeningocele—Editorial

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, w...

96KB Sizes 0 Downloads 60 Views

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.