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Erschienen in: Journal of Children's Orthopaedics 6/2009

01.12.2009 | Current Concept Review

Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities

verfasst von: Vineeta T. Swaroop, Luciano Dias

Erschienen in: Journal of Children's Orthopaedics | Ausgabe 6/2009

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Abstract

Children with spina bifida develop a wide variety of congenital and acquired orthopedic deformities. Among these are hip deformities such as contracture, subluxation, or dislocation. Patients may also have problems with the knee joint, such as knee flexion or extension contracture, knee valgus deformity, or late knee instability and pain. In addition, rotational deformities of the lower extremities, either internal or external torsion, are common as well. This paper will review both the overall orthopedic care of a patient with spina bifida and provide a focused review of the diagnosis and management of the above deformities. In addition, this paper will review the incidence, etiology, classification, and prognosis of spina bifida. The use of gait analysis and orthoses will be covered as well. The forthcoming Part II will cover foot and ankle deformities in spina bifida.
Literatur
1.
Zurück zum Zitat McLone DG, Bowman RM (2009) Overview of the management of myelomeningocele—I. In: Rose BD (ed) UpToDate. Waltham, MA McLone DG, Bowman RM (2009) Overview of the management of myelomeningocele—I. In: Rose BD (ed) UpToDate. Waltham, MA
2.
Zurück zum Zitat (2008) Neuromuscular disorders. In: Herring J (ed) Tachdjian’s pediatric orthopaedics. Saunders Elsevier, Philadelphia, pp 1405–1453 (2008) Neuromuscular disorders. In: Herring J (ed) Tachdjian’s pediatric orthopaedics. Saunders Elsevier, Philadelphia, pp 1405–1453
3.
Zurück zum Zitat Guille JT, Sarwark JF, Sherk HH, Kumar SJ (2006) Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg 14:294–302 Guille JT, Sarwark JF, Sherk HH, Kumar SJ (2006) Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg 14:294–302
4.
Zurück zum Zitat Westcott MA, Dynes MC, Remer EM, Donaldson JS, Dias LS (1992) Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics 12:1155–1173CrossRef Westcott MA, Dynes MC, Remer EM, Donaldson JS, Dias LS (1992) Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics 12:1155–1173CrossRef
5.
Zurück zum Zitat Centers for Disease Control and Prevention (CDC) (1992) Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep 41(RR-14):1–7 Centers for Disease Control and Prevention (CDC) (1992) Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep 41(RR-14):1–7
6.
Zurück zum Zitat Centers for Disease Control and Prevention (CDC) (2009) Racial/ethnic differences in the birth prevalence of spina bifida—United States, 1995–2005. MMWR Morb Mortal Wkly Rep 57(53):1409–1413 Centers for Disease Control and Prevention (CDC) (2009) Racial/ethnic differences in the birth prevalence of spina bifida—United States, 1995–2005. MMWR Morb Mortal Wkly Rep 57(53):1409–1413
7.
Zurück zum Zitat Busby A, Abramsky L, Dolk H, Armstrong B; Eurocat Folic Acid Working Group (2005) Preventing neural tube defects in Europe: population based study. BMJ 330:574–575CrossRef Busby A, Abramsky L, Dolk H, Armstrong B; Eurocat Folic Acid Working Group (2005) Preventing neural tube defects in Europe: population based study. BMJ 330:574–575CrossRef
8.
Zurück zum Zitat Padmanabhan R (2006) Etiology, pathogenesis and prevention of neural tube defects. Congenit Anom (Kyoto) 46:55–67CrossRef Padmanabhan R (2006) Etiology, pathogenesis and prevention of neural tube defects. Congenit Anom (Kyoto) 46:55–67CrossRef
9.
Zurück zum Zitat Deak KL, Boyles AL, Etchevers HC, Melvin EC, Siegel DG, Graham FL, Slifer SH, Enterline DS, George TM, Vekemans M, McClay D, Bassuk AG, Kessler JA, Linney E, Gilbert JR, Speer MC (2005) SNPs in the neural cell adhesion molecule 1 gene (NCAM1) may be associated with human neural tube defects. Hum Genet 117:133–142CrossRef Deak KL, Boyles AL, Etchevers HC, Melvin EC, Siegel DG, Graham FL, Slifer SH, Enterline DS, George TM, Vekemans M, McClay D, Bassuk AG, Kessler JA, Linney E, Gilbert JR, Speer MC (2005) SNPs in the neural cell adhesion molecule 1 gene (NCAM1) may be associated with human neural tube defects. Hum Genet 117:133–142CrossRef
10.
Zurück zum Zitat Dias L (2004) Orthopaedic care in spina bifida: past, present, and future. Dev Med Child Neurol 46:579CrossRef Dias L (2004) Orthopaedic care in spina bifida: past, present, and future. Dev Med Child Neurol 46:579CrossRef
11.
Zurück zum Zitat Mazur JM, Shurtleff D, Menelaus M, Colliver J (1989) Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair. J Bone Joint Surg Am 71:56–61 Mazur JM, Shurtleff D, Menelaus M, Colliver J (1989) Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair. J Bone Joint Surg Am 71:56–61
12.
Zurück zum Zitat Asher M, Olson J (1983) Factors affecting the ambulatory status of patients with spina bifida cystica. J Bone Joint Surg Am 65:350–356 Asher M, Olson J (1983) Factors affecting the ambulatory status of patients with spina bifida cystica. J Bone Joint Surg Am 65:350–356
13.
Zurück zum Zitat Barden GA, Meyer LC, Stelling FH 3rd (1975) Myelodysplastics—fate of those followed for twenty years or more. J Bone Joint Surg Am 57:643–647 Barden GA, Meyer LC, Stelling FH 3rd (1975) Myelodysplastics—fate of those followed for twenty years or more. J Bone Joint Surg Am 57:643–647
14.
Zurück zum Zitat Seitzberg A, Lind M, Biering-Sørensen F (2008) Ambulation in adults with myelomeningocele. Is it possible to predict the level of ambulation in early life? Childs Nerv Syst 24:231–237CrossRef Seitzberg A, Lind M, Biering-Sørensen F (2008) Ambulation in adults with myelomeningocele. Is it possible to predict the level of ambulation in early life? Childs Nerv Syst 24:231–237CrossRef
15.
Zurück zum Zitat Schopler SA, Menelaus MB (1987) Significance of the strength of the quadriceps muscles in children with myelomeningocele. J Pediatr Orthop 7:507–512CrossRef Schopler SA, Menelaus MB (1987) Significance of the strength of the quadriceps muscles in children with myelomeningocele. J Pediatr Orthop 7:507–512CrossRef
16.
Zurück zum Zitat McDonald CM, Jaffe KM, Mosca VS, Shurtleff DB (1991) Ambulatory outcome of children with myelomeningocele: effect of lower-extremity muscle strength. Dev Med Child Neurol 33:482–490CrossRef McDonald CM, Jaffe KM, Mosca VS, Shurtleff DB (1991) Ambulatory outcome of children with myelomeningocele: effect of lower-extremity muscle strength. Dev Med Child Neurol 33:482–490CrossRef
17.
Zurück zum Zitat Swank M, Dias LS (1994) Walking ability in spina bifida patients: a model for predicting future ambulatory status based on sitting balance and motor level. J Pediatr Orthop 14:715–718CrossRef Swank M, Dias LS (1994) Walking ability in spina bifida patients: a model for predicting future ambulatory status based on sitting balance and motor level. J Pediatr Orthop 14:715–718CrossRef
18.
Zurück zum Zitat Dias L (2002) Myelomeningocele and intraspinal lipoma. In: Sponseller PD (ed) Orthopaedic knowledge update: pediatrics 2nd edn. American Academy of Orthopaedic Surgeons, pp 249–259 Dias L (2002) Myelomeningocele and intraspinal lipoma. In: Sponseller PD (ed) Orthopaedic knowledge update: pediatrics 2nd edn. American Academy of Orthopaedic Surgeons, pp 249–259
19.
Zurück zum Zitat Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M (2004) The Functional Mobility Scale (FMS). J Pediatr Orthop 24(5):514–520CrossRef Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M (2004) The Functional Mobility Scale (FMS). J Pediatr Orthop 24(5):514–520CrossRef
20.
Zurück zum Zitat Battibugli S, Gryfakis N, Dias L, Kelp-Lenane C, Figlioli S, Fitzgerald E, Hroma N, Seshadri R, Sullivan C (2007) Functional gait comparison between children with myelomeningocele: shunt versus no shunt. Dev Med Child Neurol 49:764–769CrossRef Battibugli S, Gryfakis N, Dias L, Kelp-Lenane C, Figlioli S, Fitzgerald E, Hroma N, Seshadri R, Sullivan C (2007) Functional gait comparison between children with myelomeningocele: shunt versus no shunt. Dev Med Child Neurol 49:764–769CrossRef
21.
Zurück zum Zitat Dunteman RC, Vankoski SJ, Dias LS (2000) Internal derotation osteotomy of the tibia: pre- and postoperative gait analysis in persons with high sacral myelomeningocele. J Pediatr Orthop 20:623–628CrossRef Dunteman RC, Vankoski SJ, Dias LS (2000) Internal derotation osteotomy of the tibia: pre- and postoperative gait analysis in persons with high sacral myelomeningocele. J Pediatr Orthop 20:623–628CrossRef
22.
Zurück zum Zitat Gabrieli APT, Vankoski SJ, Dias LS, Milani C, Lourenco A, Filho JL, Novak R (2003) Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation. J Pediatr Orthop 23:330–334 Gabrieli APT, Vankoski SJ, Dias LS, Milani C, Lourenco A, Filho JL, Novak R (2003) Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation. J Pediatr Orthop 23:330–334
23.
Zurück zum Zitat Moen T, Gryfakis N, Dias L, Lemke L (2005) Crouched gait in myelomeningocele: a comparison between the degree of knee flexion contracture in the clinical examination and during gait. J Pediatr Orthop 25(5):657–660CrossRef Moen T, Gryfakis N, Dias L, Lemke L (2005) Crouched gait in myelomeningocele: a comparison between the degree of knee flexion contracture in the clinical examination and during gait. J Pediatr Orthop 25(5):657–660CrossRef
24.
Zurück zum Zitat Vankoski S, Moore C, Statler KD, Sarwark JF, Dias L (1997) The influence of forearm crutches on pelvic and hip kinematics in children with myelomeningocele: don’t throw away the crutches. Dev Med Child Neurol 39:614–619CrossRef Vankoski S, Moore C, Statler KD, Sarwark JF, Dias L (1997) The influence of forearm crutches on pelvic and hip kinematics in children with myelomeningocele: don’t throw away the crutches. Dev Med Child Neurol 39:614–619CrossRef
25.
Zurück zum Zitat Duffy CM, Hill AE, Cosgrove AP, Corry IS, Mollan RA, Graham HK (1996) Three-dimensional gait analysis in spina bifida. J Pediatr Orthop 16:786–791CrossRef Duffy CM, Hill AE, Cosgrove AP, Corry IS, Mollan RA, Graham HK (1996) Three-dimensional gait analysis in spina bifida. J Pediatr Orthop 16:786–791CrossRef
26.
Zurück zum Zitat Swaroop VT, Dias LS (2008) What is the optimal treatment for hip and spine in myelomeningocele? In: Wright JG (ed) Evidence-based orthopaedics. Elsevier Health Sciences, Amsterdam, pp 273–277 Swaroop VT, Dias LS (2008) What is the optimal treatment for hip and spine in myelomeningocele? In: Wright JG (ed) Evidence-based orthopaedics. Elsevier Health Sciences, Amsterdam, pp 273–277
27.
Zurück zum Zitat Sherk HH, Ames MD (1978) Functional results of iliopsoas transfer in myelomeningocele hip dislocations. Clin Orthop Relat Res 137:181–186 Sherk HH, Ames MD (1978) Functional results of iliopsoas transfer in myelomeningocele hip dislocations. Clin Orthop Relat Res 137:181–186
28.
Zurück zum Zitat Feiwell E, Sakai D, Blatt T (1978) The effect of hip reduction on function in patients with myelomeningocele. Potential gains and hazards of surgical treatment. J Bone Joint Surg Am 60:169–173 Feiwell E, Sakai D, Blatt T (1978) The effect of hip reduction on function in patients with myelomeningocele. Potential gains and hazards of surgical treatment. J Bone Joint Surg Am 60:169–173
29.
Zurück zum Zitat Sherk HH, Uppal GS, Lane G, Melchionni J (1991) Treatment versus non-treatment of hip dislocations in ambulatory patients with myelomeningocele. Dev Med Child Neurol 33:491–494CrossRef Sherk HH, Uppal GS, Lane G, Melchionni J (1991) Treatment versus non-treatment of hip dislocations in ambulatory patients with myelomeningocele. Dev Med Child Neurol 33:491–494CrossRef
30.
Zurück zum Zitat Swaroop VT, Dias LS (2009) Strategies of hip management in myelomeningocele: to do or not to do. Hip Int 19:S53–S55 Swaroop VT, Dias LS (2009) Strategies of hip management in myelomeningocele: to do or not to do. Hip Int 19:S53–S55
31.
Zurück zum Zitat Feiwell E (1980) Surgery of the hip in myelomeningocele as related to adult goals. Clin Orthop Relat Res 148:87–93 Feiwell E (1980) Surgery of the hip in myelomeningocele as related to adult goals. Clin Orthop Relat Res 148:87–93
32.
Zurück zum Zitat Dias LS (1982) Surgical management of knee contractures in myelomeningocele. J Pediatr Orthop 2:127–131CrossRef Dias LS (1982) Surgical management of knee contractures in myelomeningocele. J Pediatr Orthop 2:127–131CrossRef
33.
Zurück zum Zitat Marshall PD, Broughton NS, Menelaus MB, Graham HK (1996) Surgical release of knee flexion contractures in myelomeningocele. J Bone Joint Surg Br 78:912–916CrossRef Marshall PD, Broughton NS, Menelaus MB, Graham HK (1996) Surgical release of knee flexion contractures in myelomeningocele. J Bone Joint Surg Br 78:912–916CrossRef
34.
Zurück zum Zitat Sandhu PS, Broughton NS, Menelaus MB (1995) Tenotomy of the ligamentum patellae in spina bifida: management of limited flexion range at the knee. J Bone Joint Surg Br 77:832–833 Sandhu PS, Broughton NS, Menelaus MB (1995) Tenotomy of the ligamentum patellae in spina bifida: management of limited flexion range at the knee. J Bone Joint Surg Br 77:832–833
35.
Zurück zum Zitat Williams JJ, Graham GP, Dunne KB, Menelaus MB (1993) Late knee problems in myelomeningocele. J Pediatr Orthop 13:701–703CrossRef Williams JJ, Graham GP, Dunne KB, Menelaus MB (1993) Late knee problems in myelomeningocele. J Pediatr Orthop 13:701–703CrossRef
36.
Zurück zum Zitat Selber P, Dias L (1998) Sacral-level myelomeningocele: long-term outcome in adults. J Pediatr Orthop 18:423–427 Selber P, Dias L (1998) Sacral-level myelomeningocele: long-term outcome in adults. J Pediatr Orthop 18:423–427
37.
Zurück zum Zitat Lim R, Dias L, Vankoski S, Moore C, Marinello M, Sarwark J (1998) Valgus knee stress in lumbosacral myelomeningocele: a gait-analysis evaluation. J Pediatr Orthop 18:428–433 Lim R, Dias L, Vankoski S, Moore C, Marinello M, Sarwark J (1998) Valgus knee stress in lumbosacral myelomeningocele: a gait-analysis evaluation. J Pediatr Orthop 18:428–433
38.
Zurück zum Zitat Dias LS, Jasty MJ, Collins P (1984) Rotational deformities of the lower limb in myelomeningocele. Evaluation and treatment. J Bone Joint Surg Am 66:215–223 Dias LS, Jasty MJ, Collins P (1984) Rotational deformities of the lower limb in myelomeningocele. Evaluation and treatment. J Bone Joint Surg Am 66:215–223
39.
Zurück zum Zitat Dodgin DA, De Swart RJ, Stefko RM, Wenger DR, Ko JY (1998) Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. J Pediatr Orthop 18:95–101 Dodgin DA, De Swart RJ, Stefko RM, Wenger DR, Ko JY (1998) Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. J Pediatr Orthop 18:95–101
40.
Zurück zum Zitat Vankoski SJ, Michaud S, Dias L (2000) External tibial torsion and the effectiveness of the solid ankle-foot orthoses. J Pediatr Orthop 20:349–355 Vankoski SJ, Michaud S, Dias L (2000) External tibial torsion and the effectiveness of the solid ankle-foot orthoses. J Pediatr Orthop 20:349–355
41.
Zurück zum Zitat Fraser RK, Menelaus MB (1993) The management of tibial torsion in patients with spina bifida. J Bone Joint Surg Br 75:495–497 Fraser RK, Menelaus MB (1993) The management of tibial torsion in patients with spina bifida. J Bone Joint Surg Br 75:495–497
Metadaten
Titel
Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities
verfasst von
Vineeta T. Swaroop
Luciano Dias
Publikationsdatum
01.12.2009
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Children's Orthopaedics / Ausgabe 6/2009
Print ISSN: 1863-2521
Elektronische ISSN: 1863-2548
DOI
https://doi.org/10.1007/s11832-009-0214-5

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