Database : MEDLINE
Search on : C05.550.323.468 [DeCS Category]
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PMID:28594688
Author:van Bosse HJP; Pontén E; Wada A; Agranovich OE; Kowalczyk B; Lebel E; Senaran H; Derevianko DV; Vavilov MA; Petrova EV; Barsukov DB; Batkin SF; Eylon S; Kenis VM; Stepanova YV; Buklaev DS; Yilmaz G; Köse O; Trofimova SI; Durgut F
Address:*Shriners Hospitals for Children, Philadelphia, PA †Department of Pediatric Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden ‡Department of Orthopaedic Surgery, Saga Handicapped Children's Hospital, Saga, Japan §Arthrogryposis Clinic, Turner Scientific and Research Institute for Children's Orthopedics, Saint Petersburg, Russia ††Turner Scientific and Research Institute for Children's Orthopedics §§Department of Foot and Ankle Surgery, Neuroorthopaedics and Systemic Disorders, Turner Scientific and Research Institute for Children's Orthopedics, Saint Petersburg **Yaroslavl Regional Children's Hospital, Yaroslavl, Russia ∥Department of Pediatric Orthopedics and Trauma Surgery, University Children's Hospital of Krakow, Krakow, Poland ¶ALYN Rehabilitation Hospital for Children and Adolescents, and Pediatric Orthopedic Service, Shaare-Zedek Medical Center #Faculty of Medicine, Selcuk University, Konya, and Faculty of Medicine, Erzincan University, Erzincan, Turkey ∥∥Department of Orthopedics and Traumatology, Medical School of Selcuk University ¶¶Konya Bozkir State Hospital ##Department of Orthopedics and Traumatology, Meram University Hospital and Selçuk University Faculty of Medicine, Konya, Turkey.
Title:Treatment of the Lower Extremity Contracture/Deformities.
Source:J Pediatr Orthop; 37 Suppl 1:S16-S23, 2017 Jul/Aug.
ISSN:1539-2570
Country of publication:United States
Language:eng
Abstract:Lower extremity deformities of patients with arthrogryposis multiplex congenita present a wide spectrum of severity and deformity combinations. Treatment goals range from merely ensuring comfortable seating and shoe wear, to fully independent and active ambulation, but the overarching intention is to help realize the patient's greatest potential for independence and function. Treatment of hip and knee contractures and dislocations has become more interventional, whereas treatment of foot deformities has paradoxically become much less surgical. This article synopsizes the treatment strategies presented in September 2014 in Saint Petersburg, Russia at the second international symposium on arthrogryposis.
Publication type:JOURNAL ARTICLE


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PMID:28060234
Author:van Bosse HJ; Saldana RE
Address:1Shriners Hospital for Children, Philadelphia, Pennsylvania 2Miami Orthopedics & Sports Medicine Institute, Baptist Health Medical Group, Miami, Florida.
Title:Reorientational Proximal Femoral Osteotomies for Arthrogrypotic Hip Contractures.
Source:J Bone Joint Surg Am; 99(1):55-64, 2017 Jan 04.
ISSN:1535-1386
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Severe hip contractures in arthrogrypsosis are multiplanar, which can preclude or can greatly complicate sitting and ambulation. The reorientational osteotomy at the intertrochanteric level preserves preoperative hip motion but moves it to a more functional domain. We retrospectively compared preoperative and postoperative hip motion and evaluated the ambulatory abilities of patients who underwent the procedure. METHODS: Since 2008, 65 patients with arthrogryposis had 119 reorientational proximal femoral osteotomies with a minimum follow-up of 2 years. The mean patient age at the time of the surgical procedure was 48 months. An intertrochanteric wedge osteotomy aligned the femoral shaft with the body axis, leaving the hip joint in its preexisting position. A cannulated hip blade plate was used for fixation. Hip motions were recorded preoperatively, at implant removal, and at the time of the latest follow-up, as was ambulatory ability. RESULTS: Eighty-one hips had a mean flexion contracture of 52° preoperatively, which improved by 35°; 84 hips with a mean preoperative adduction of -20° improved by 42°; 101 hips with a mean preoperative internal rotation of -16° improved by 35° (p < 0.0001 for all). The flexion-extension total arc of motion for the 119 hips improved by 13° (p < 0.0001). Only 11 of 94 hips that preoperatively flexed ≥90° did not do so postoperatively, but none of the patients reported seating difficulties and one of the patients had already regained hip flexion of >90° by a soft-tissue release. At a mean follow-up of 40 months, 36 patients were independently ambulatory and 20 patients were walker-dependent. CONCLUSIONS: Children with arthrogryposis often have the potential for ambulation if the limb positioning can be optimized. The reorientational hip osteotomy corrects the hip contractures by altering the range of motion but not the total arc of motion. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE


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PMID:26130283
Author:Al Bayati MA; Kraidy BK
Address:Al Wasity Teaching Hospital, PO Box 38032, Baghdad, Iraq. mabayatti@yahoo.com.
Title:Gluteal muscle fibrosis with abduction contracture of the hip.
Source:Int Orthop; 40(3):447-51, 2016 Mar.
ISSN:1432-5195
Country of publication:Germany
Language:eng
Abstract:PURPOSE: Gluteal muscle fibrosis with hip contracture is a rare condition and causes major disability; literature reports are sparse. The aim of this study is to present, for the first time in Iraq and the region, a case series of gluteal fibrosis and the results of surgical treatment. METHODS: Seven children--six boys and one girl--diagnosed as having gluteal muscle fibrosis with hip contracture, were investigated and treated by open surgical release of fibrotic bands and physiotherapy. RESULTS: All patients improved dramatically over the subsequent weeks, and were able to sit and squat in the normal position. CONCLUSIONS: Gluteal muscle fibrosis with hip contracture is present in Iraq and more awareness is needed for early diagnosis. Surgical treatment provided excellent results. More studies are needed to delineate the aetiology of the condition.
Publication type:JOURNAL ARTICLE


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PMID:26905552
Author:Sahu RL
Address:SMS & RI Sharda University, Uttar Pradesh, India.
Title:Percutaneous Adductor Release in Nonambulant Children with Cerebral Palsy.
Source:JNMA J Nepal Med Assoc; 52(193):702-6, 2014 Jan-Mar.
ISSN:0028-2715
Country of publication:Nepal
Language:eng
Abstract:INTRODUCTION: Adductor spasticity at hips is the main barrier in functional activities and rehabilitation of spastic cerebral palsy patients. The aim of this study is to evaluate the results of percutaneous adductor release under general anaesthesia. METHODS: From July 2005 to July 2010, 64 hips in 32 patients (19 males and 13 females) were recruited from outpatient department having adductor contracture at hips in cerebral palsy children. All children were operated under general anaesthesia. All children were followed for twenty-four months. The clinical results were evaluated radiologically, including measurement of CE- angle, AC-index and femoral head coverage and in terms of activity level of children. RESULTS: Of the thirty-two children, twenty-eight showed marked and immediate improvement. None of our children was functionally worse at follow-up. The CE-angle and femoral head coverage did not change significantly. The AC-index improved significantly (P = 0.01).The results were excellent in 12.5% children, good in 50%, fair in 25% and poor in 12.5%. CONCLUSIONS: Bilateral mini-invasive adductor release can be an effective treatment for children suffering from adductor contracture refractory to nonoperative management and early adductor release can prevent subluxation and possibly the need for future bony procedure on the proximal femur and pelvis.
Publication type:JOURNAL ARTICLE


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PMID:25430710
Author:Al Kaissi A; Kenis V; Melchenko E; Chehida FB; Ganger R; Klaushofer K; Grill F
Address:Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria; Paediatric Department, Orthopaedic Hospital of Speising, Vienna, Austria.
Title:Corrections of lower limb deformities in patients with diastrophic dysplasia.
Source:Orthop Surg; 6(4):274-9, 2014 Nov.
ISSN:1757-7861
Country of publication:Australia
Language:eng
Abstract:OBJECTIVE: Accurate understanding of the cause of the underlying pathology in children with diastrophic dysplasia would help in designing targeted management of their locomotion. METHODS: Diastrophic dysplasia was diagnosed in twelve patients (nine girls and three boys; age range 1-14 years), all of whom presented with small stature and apparent short extremities. Club foot (mostly talipes equinovarus) was the most frequent and consistent abnormality. Concomitant abnormalities such as hip flexion contracture, flexion contractures of the knees with excessive valgus deformity and lateral patellar subluxation, were also encountered. Muscle ultrasound and muscle magnetic resonance imaging imaging showed no myopathic changes and muscle biopsies and the respiratory chain were normal. Serum choline kinase and plasma lactate concentrations were normal. RESULTS: Surgical correction of the foot and ankle in patients with diastrophic dysplasia is extremely difficult because of the markedly distorted anatomy. In all of these children, plantigrade foot was achieved along with the improved function of the locomotor system. Mutations of the diastrophic dysplasia sulfate transporter (also known as solute carrier family 26 member 2) were encountered. CONCLUSION: Arthrogryposis multiplex is the usual terminology used to describe the abnormality in infants with multiple contractures. Diligent orthopaedic care should be provided based on an accurate understanding of the associated syndromes in such children.
Publication type:EVALUATION STUDIES; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


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PMID:25214532
Author:Young SW; Dakic J; Stroia K; Nguyen ML; Harris AH; Safran MR
Address:Department of Orthopaedic Surgery, North Shore Hospital, University of Auckland, Auckland, New Zealand.
Title:Hip range of motion and association with injury in female professional tennis players.
Source:Am J Sports Med; 42(11):2654-8, 2014 Nov.
ISSN:1552-3365
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Adequate hip range of motion is required for the transfer of energy from the lower to the upper extremity along the kinetic chain. Repetitive rotational stresses in the lower extremities during tennis may lead to sport-specific range of motion adaptations, which may increase the risk of injury to other joints along the kinetic chain. PURPOSE: To assess whether such range of motion adaptations occur in the hip, and if so, to identify whether they are associated with injury. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 125 female professional tennis players, the majority of whom were ranked in the top 200 World Tennis Association singles rankings, underwent a comprehensive preparticipation physical health status examination. Hip range of motion was assessed using a digital inclinometer and side-to-side differences in rotational parameters calculated, and associations with previous injuries were identified. RESULTS: A history of an abdominal strain was reported by 10% of players, and there was an association between abdominal strains and the presence of hip flexion contractures (odds ratio, 6.1; P = .006). Hip flexion contractures were bilateral in 85% of those found, affected only the nondominant side in 9%, and affected only the dominant side in 6%. We were unable to identify any specific side-to-side rotational adaptations in the dominant or nondominant hips, and no association between loss of hip range of motion and shoulder, lower back, hip, knee, or ankle injuries was found. CONCLUSION: We report an association in female professional tennis players between abdominal strains and flexion contractures of the hip with iliopsoas tightness. We did not find evidence of specific hip adaptations in rotational range of motion. If hip flexion contractures are found on clinical examination, a stretching program may be indicated. Further studies are required to assess whether such a program can reduce the risk of abdominal injury.
Publication type:JOURNAL ARTICLE


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PMID:25152080
Author:Bálint Z; Farkas H; Farkas N; Minier T; Kumánovics G; Horváth K; Solyom AI; Czirják L; Varjú C
Address:Department of Rheumatology and Immunology Clinic Centre, University of Pécs, Hungary. balint.zsofia@pte.hu.
Title:A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis.
Source:Clin Exp Rheumatol; 32(6 Suppl 86):S-68-74, 2014 Nov-Dec.
ISSN:0392-856X
Country of publication:Italy
Language:eng
Abstract:OBJECTIVES: To analyse the correlation between the number of joint-contractures and other major clinical findings in a follow-up study of 131 patients with systemic sclerosis (SSc). METHODS: The range of motion of joints (ROM), HAQ-DI, and the major clinical characteristics were assessed. RESULTS: A high frequency of contractures (ROM<75% of the normal) were present at baseline in small joints of the hand (82%), wrists (75%), and shoulders (50%). ROM of the dominant side hand was significantly more decreased compared to the non-dominant side. The number of the upper extremity contractures correlated positively with ESR (p<0.01), CRP (p<0.01), HAQ-DI (p<0.01), and negatively with forced vital capacity (FVC) (p<0.05). The number of contractures was not significantly different in cases with early (≤ 4 years) and late disease duration in both the limited and diffuse subgroups. During the three-year follow-up period, an increase in the number of joint contractures (ROM<75%) was associated with an increase of ESR, modified Rodnan's skin score, and the European Scleroderma Study Group Activity Index by multiple linear regression analysis. Univariate analysis over a six-year period demonstrated poor outcome in patients with more than ten contractures, or more than four contractures of unilateral hand-joints. CONCLUSIONS: Contractures predominantly develop during the early years following disease onset in both SSc subgroups. Inflammation and skin-involvement are significant contributing factors for the development of contractures. The dominant hand may be more pronouncedly impaired compared to the non-dominant side. A high number of joint-contractures might be an unfavourable prognostic factor in SSc.
Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Name of substance:9007-41-4 (C-Reactive Protein)


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PMID:24762848
Author:Pourtaheri S; Emami A; Stewart T; Hwang K; Issa K; Harwin SF; Mont MA
Title:Hip flexion contracture caused by an intraspinal osteochondroma of the lumbar spine.
Source:Orthopedics; 37(4):e398-402, 2014 Apr.
ISSN:1938-2367
Country of publication:United States
Language:eng
Abstract:Osteochondroma (or osteocartilaginous exostosis) is the most common bone tumor of childhood, with an incidence ranging from 1 to 1.4 per 1,000,000. In the lumbar spine, osteochondromata usually arise from the posterior column at the secondary ossification center and grow away from the spinal canal without causing neurologic deficits. This article reports a rare intraspinal lumbar osteochondroma that compressed the thecal sac, resulting in a hip flexion contracture in an 11-year-old boy. This lumbar, intraspinal, extradural exostosis was confluent with the L3 inferior articular process and compressed the L3 nerve root and thecal sac severely. The patient underwent an en bloc resection of the tumor with a right-sided hemilaminectomy of L3 and L4, a right-sided partial facetectomy at L3 to L4, and an extended resection from the pars intra-articularis of the L2 to the L5 vertebrae. The tumor specimen measured 4.8×3.7×2.5 cm with clear margins. Instrumented posterolateral fusion was completed from L2 to L5 due to iatrogenic instability from the resection. The patient had an uneventful recovery and returned to his normal activities of daily living, including sports. He remains asymptomatic at 54-month follow-up. A solitary lumbar osteochondroma that compresses the spinal cord, resulting in a motor neurological deficit, has not been reported in a pediatric patient. Orthopedic surgeons should be aware of potential intraspinal presentation of osteochondromas. Magnetic resonance imaging is the modality of choice in diagnosing and screening for spinal osteochondromas. These cases can be treated with resection surgery.
Publication type:CASE REPORTS; JOURNAL ARTICLE


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PMID:24579232
Author:Dhamangaonkar AC; Joshi D; Goregaonkar AB; Phalak M
Title:Pelvic deformity secondary to tensor fascia lata tightness associated with desmoid tumor.
Source:Orthopedics; 36(12):e1563-6, 2013 Dec.
ISSN:1938-2367
Country of publication:United States
Language:eng
Abstract:The iliotibial band is a thick, condensed fascia that, when contracted, leads to a hip flexion, abduction, and external rotation contracture in addition to other joint contractures. Iliotibial band tightness occurs secondary to iliotibial band friction syndrome, which commonly occurs at the lateral femoral epicondylar region. However, a proximal cause of iliotibial band/tensor fascia lata friction syndrome leading to a secondary hip contracture is swelling around the hip; this swelling being a desmoid tumor has not been explicitly described in the literature. The authors present a rare case of a hip contracture in a 28-year-old active man who presented with a functionally disabling hip flexion contracture of 20° with further flexion possible up to 130°, a 45° abduction contracture, and a 20° external rotation contracture with further rotation possible up to 40° with a bony hard swelling in the left gluteal region. Ober's test was positive. Opposite hip and spine examinations were normal. The goals of treatment were to establish the causality between the 2 and to diagnose the etiology of the gluteal mass. Radiographs were normal, with only a pelvic obliquity evident. Magnetic resonance imaging revealed an extra-articular mass abutting the iliac blade. Histopathology confirmed the mass to be a desmoid tumor in the left gluteal region. A wide surgical excision of the mass was performed with negative margins; no postoperative radiotherapy was administered. After rigorous physiotherapy, the hip deformity disappeared at 6 months and there was no evidence of recurrence at 2.5-year follow-up, with the patient able to sit cross-legged and squat.
Publication type:CASE REPORTS; JOURNAL ARTICLE


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PMID:24140953
Author:Böhm H; Dussa CU; Multerer C; Döderlein L
Address:Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany. Electronic address: h.boehm@bz-aschau.de.
Title:Pathological trunk motion during walking in children with amyoplasia: is it caused by muscular weakness or joint contractures?
Source:Res Dev Disabil; 34(11):4286-92, 2013 Nov.
ISSN:1873-3379
Country of publication:United States
Language:eng
Abstract:The aim was to investigate the causes for pathological trunk movements during gait in children with Amyoplasia. Eighteen children with Amyoplasia were compared with 18 typically developed children. Three-dimensional motions of pelvis, thorax and spine during gait were analyzed. Excessive trunk movements were defined as being above 4 standard deviations of those of typically developed children. Clinical examination of active strength and passive range of motion of the hip, knee and ankle joints were correlated to the parameter that showed the greatest prevalence of pathological trunk motion. The greatest prevalence of 56% was seen for thorax obliquity range during walking. The spine angles showed the lowest deviations from typically developed children. Significant correlations (p<0.001) between thorax obliquity range and clinical parameters were found for passive hip extension, hip flexion, hip abduction and active hip extension, hip flexion and ankle dorsiflexion strength. The highest correlation coefficients were found for passive hip flexion and active hip flexion strength of rho=-0.73 and rho=-0.69 respectively. Excessive thorax obliquity during gait in children with Amyoplasia could be mainly caused by reduced strength and mobility of the hip. Therefore both mobility and strength of the hip are equally important and should be increased in the therapy to improve gait in children with Amyoplasia.
Publication type:JOURNAL ARTICLE



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