Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Pediatrics 104 articles


Rectus Femoris Transfer Improves Stiff Knee Gait in Children With Spastic Cerebral Palsy

Dinesh Thawrani MD, Thierry Haumont MD, Chris Church MS, PT, Larry Holmes PhD, DrPH, Kirk W. Dabney MD, Freeman Miller MD

Stiff knee gait is common among children with ambulatory cerebral palsy (CP). When surgery is indicated, rectus femoris transfer as a primary treatment enhances knee range of motion, reduces time to peak knee flexion, increases peak knee flexion, and reduces toe drag.

Pathomechanics of Gowers’ Sign: A Video Analysis of a Spectrum of Gowers’ Maneuvers

Richard F. Chang MD, Scott J. Mubarak MD

Gowers’ sign is a screening test for muscle weakness, typically seen in Duchenne muscular dystrophy but also seen in numerous other conditions. The mildest presentations and the variations of Gowers’ sign are poorly described in the literature but are important to recognize to help with early diagnosis of a neuromuscular problem.

Low Early Failure Rates Using a Surgical Dislocation Approach in Healed Legg-Calvé-Perthes Disease

Benjamin J. Shore MD, FRCSC, Eduardo N. Novais MD, Michael B. Millis MD, Young-Jo Kim MD, PhD

Hip deformity secondary to Legg-Calvé Perthes disease (LCPD) may result in femoroacetabular impingement (FAI) and ultimately osteoarthritis. Observations made with the surgical hip dislocation approach have improved our understanding of the pathologic mechanics of FAI. However, owing to concerns about complications related to the vascularity, the role of surgical hip dislocation in the treatment of healed LCPD remains controversial.

Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Patricia Maria Moraes Barros Fucs MD, PhD, Celso Svartman MD, Rodrigo Montezuma Cezar Assumpção MD, Helder Henzo Yamada MD, Simone Dota Simis MD

Treatment of spastic planovalgus feet is challenging, especially in patients with severe and rigid deformities. The available techniques do provide some correction but not at the site of the deformity and sometimes the correction is lost over time. We describe a new surgical approach at the site of the deformity.

Varus Femoral Osteotomy Improves Sphericity of the Femoral Head in Older Children With Severe Form of Legg-Calvé-Perthes Disease

Terje Terjesen MD, PhD, Ola Wiig MD, PhD, Svein Svenningsen MD, PhD

In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%.

Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

Jacques Riad MD, Christopher M. Modlesky PhD, E. M. Gutierrez-Farewik PhD, Eva Broström PT, PhD

Individuals with spastic hemiplegic cerebral palsy are typically high functioning and walk without assistive devices. The involved limb is usually smaller and shorter, although it is not clear whether the difference in muscle volume has an impact on walking capacity.

Standardized Diagnostic Criteria for Developmental Dysplasia of the Hip in Early Infancy

Andreas Roposch MD, MSc, FRCS, Liang Q. Liu MBBS, PhD, Fritz Hefti MD, Nicholas M. P. Clarke ChM, FRCS, John H. Wedge OC, MD, FRCS(C)

Clinicians use various criteria to diagnose developmental dysplasia of the hip (DDH) in early infancy, but the importance of these various criteria for a definite diagnosis is controversial. The lack of uniform, widely agreed-on diagnostic criteria for DDH in patients in this age group may result in a delay in diagnosis of some patients.

Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy

Lisa V. Wagner MHS, OTR/L, Jon R. Davids MD

Clinicians interested in assessment and outcome measurement of upper extremity (UE) function and performance in children with cerebral palsy (CP) must choose from a wide range of tools.

Case Reports: The Influence of Selective Voluntary Motor Control on Gait After Hamstring Lengthening Surgery

Evan J. Goldberg PhD, Eileen G. Fowler PhD, PT, William L. Oppenheim MD

Preliminary evidence suggests selective voluntary motor control (SVMC), defined as performance of isolated voluntary joint movement on request, may be an important factor affecting functional movement tasks. Individuals with poor SVMC are unable to dissociate hip and knee synergistic movement during the swing phase of gait and have difficulty extending their knee while the hip is flexing during terminal swing regardless of hamstring length. This pattern may limit their ability to take advantage of hamstring-lengthening surgery (HLS) and may explain a lack of improved stride length postoperatively.

Surgical Technique: Lower Limb-length Equalization by Periosteal Stripping and Periosteal Division

Noppachart Limpaphayom MD, Pairatch Prasongchin MD

Stimulating growth in the shorter limb in patients with a lower limb length discrepancy (LLD) theoretically is a better alternative than retarding growth in the longer limb since it would not lead to loss of height. Periosteal stripping and/or division (PSPD) have been studied in animal models and in humans with encouraging results. We combined these procedures and used it to equalize lower limb length.