Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Pediatrics 104 articles


How Does Participation of Youth With Spina Bifida Vary by Age?

Erin H. Kelly PhD, Haluk Altiok MD, Julie A. Gorzkowski MSW, LSW, Jennifer R. Abrams MSW, LSW, Lawrence C. Vogel MD

Youth with disabilities are at risk for decreased participation in community activities. However, little is known about participation at different developmental periods of childhood and adolescence among youth with spina bifida (SB) or whether child, family, and SB-associated factors influence participation.

Correlation of Spine Deformity, Lung Function, and Seat Pressure in Spina Bifida

Jayesh Patel MD, Janet L. Walker MD, Vishwas R. Talwalkar MD, Henry J. Iwinski MD, Todd A. Milbrandt MD

Spinal deformity, a common problem in children with myelodysplasia, is associated with alterations in pulmonary function and sitting balance. Sitting imbalance causes areas of high pressure in patients already at high risk for developing pressure ulcers due to insensate skin.

What Variables Influence the Ability of an AFO to Improve Function and When Are They Indicated?

Bryan S. Malas CO, MHPE

Children with spina bifida often present with functional deficits of the lower limb associated with neurosegmental lesion levels and require orthotic management. The most used orthosis for children with spina bifida is the ankle–foot orthosis (AFO). The AFO improves ambulation and reduces energy cost while walking. Despite the apparent benefits of using an AFO, limited evidence documents the influence of factors predicting the ability of an AFO to improve function and when they are indicated. These variables include AFO design, footwear, AFO–footwear combination, and data acquisition. When these variables are not adequately considered in clinical decision-making, there is a risk the AFO will be abandoned prematurely or the patient’s stability, function, and safety compromised.

Vascular Abnormalities Correlate with Decreased Soft Tissue Volumes in Idiopathic Clubfoot

Laura J. Merrill MD, Christina A. Gurnett MD, PhD, Marilyn Siegel MD, Sushil Sonavane MD, Matthew B. Dobbs MD

Lower extremity vascular anomalies have been described for patients with clubfoot but few imaging studies have investigated effects on soft tissues such as fat and muscle. To make these assessments we need noninvasive, noncontrast agents to more safely image children.

Activity Level, Functional Health, and Quality of Life of Children with Myelomeningocele as Perceived by Parents

Ann Flanagan PT, PCS, Marianne Gorzkowski BSN, RN, Haluk Altiok MD, Sahar Hassani MS, Kwang Woo Ahn PhD

To provide the best health care for individuals with myelomeningocele (MM), clinicians and researchers need to understand their health and functional status as well as quality of life. The literature is mixed regarding the relationship between motor level and health-related quality of life (HRQOL) for these individuals.

Kyphectomy Improves Sitting and Skin Problems in Patients with Myelomeningocele

Sumeet Garg MD, Matthew Oetgen MD, Karl Rathjen MD, B. Stephens Richards MD

Progressive kyphosis occurs in up to 20% of patients with myelomeningocele. Severely affected patients can develop recurrent skin breakdown, osteomyelitis, sitting imbalance, and poor cosmetic appearance.

Kyphectomy in Children with Myelomeningocele

Haluk Altiok MD, Craig Finlayson MD, Sahar Hassani MS, Peter Sturm MD

Patients with myelomeningocele and rigid lumbar and thoracolumbar kyphosis face substantial functional difficulties with sitting and lying supine and are prone to skin breakdown over the gibbus and risk of infection. Kyphectomy, along with cordotomy and segmental spinal instrumentation down to the pelvis, is one alternative that can provide reliable correction of the deformity but also can maintain that correction over a period of time.

Limb Lengthening and Deformity Correction by the Ilizarov Technique in Type III Fibular Hemimelia: An Alternative to Amputation

Maurizio A. Catagni MD, Makram Radwan MD, Luigi Lovisetti MD, Francesco Guerreschi MD, Nabil A. Elmoghazy MD

Fibular hemimelia is partial or total aplasia of the fibula; it represents the most frequent congenital defect of the long bones. It usually is associated with other anomalies of the tibia, femur, and foot.

Children with Spina Bifida are at Risk for Low Bone Density

Elizabeth A. Szalay MD, CCD, Asad Cheema

Patients with spina bifida frequently sustain lower extremity fractures which may be difficult to diagnose because they feel little or no pain, although the relative contributions of low bone density to pain insensitivity are unclear. Routine dual-energy xray absorptiometry (DXA) scanning is unreliable because these patients lack bony elements in the spine, and many have joint contractures and/or implanted hardware.

Early Definitive Spinal Fusion in Young Children: What We Have Learned

Lori A. Karol MD

Early-onset scoliosis, when left untreated, leads to severe deformity. Until the last decade, treatment of progressive curves in young children often consisted of definitive spinal fusion. The recognition of thoracic insufficiency syndrome associated with definitive early fusion has led to the development of new surgical techniques developed to preserve spinal and thoracic growth in young patients with progressive scoliosis.