Alexandre Francisco de Lourenço

Treatment of residual adduction deformity in clubfoot: the double osteotomy.

Forefoot adduction is the most common residual deformity after clubfoot surgery. Surgical treatment of this deformity is often required for moderate and severe cases. This study reports the results of a closing wedge osteotomy of the cuboid and opening wedge osteotomy of the medial cuneiform in 39 feet. The average follow-up was 4.8 years. Clinical and radiographic improvement was seen in all patients, and no complications were seen. Surgery is advocated in children older than age 4, or when the medial cuneiform ossific nucleus is well developed.

Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation.

The surgical indications for the treatment of unilateral hip dislocations or subluxations in patients with low lumbar myelomeningocele remain highly debatable. This study examines the influence of unilateral hip dislocation or subluxation on the gait of these patients using three-dimensional gait analysis. Twenty patients with a diagnosis of low lumbar myelomeningocele underwent three-dimensional gait analysis. All patients were community ambulators with solid ankle-foot orthoses and crutches who presented with unilateral hip dislocation or subluxation and no scoliosis. The patients were divided in two groups. Group 1 comprised 10 patients who demonstrated either no evidence of hip flexion or adduction contractures or symmetric hip contractures. Group 2 comprised 10 patients with unilateral hip flexion and/or adduction contractures. Pelvic and hip kinematics were assessed to determine the symmetry of motion between the involved and the noninvolved side during walking. Seven patients from group 1 walked with a symmetric gait pattern; only two patients from group 2 walked with a symmetric pattern. Gait symmetry corresponded to the absence of hip contractures or bilateral symmetrical hip contractures and had no relation to the presence of hip dislocation. The authors concluded that reduction of the hip is unnecessary.

Análise laboratorial de marcha na mielomeningocele de nível lombar baixo e instabilidade unilateral do quadril

This study examines the influence of unilateral hip dislocation or subluxation in the gait of 20 low-lumbar myelomeningocele patients, community ambulators with AFOs and crutches, utilizing gait analysis. The patients were divided in two groups, Group 1 - 10 patients: complete absence or presence of symmetrical hip contractures (flexion and/or adduction) and Group 2 -10 patients : presence of unilateral or asymmetrical hip contractures. Pelvic and hip kinematics were analyzed to assess the symmetry of them, between the involved and the non-involved side. Gait was considered symmetrical in 7 studies in Group 1 and in 2 studies in Group 2. Assymmetrical gait was found in 3 studies of Group 1 and in 8 studies in Group 2. Gait symmetry was correlated with the absence of hip contractures or bilateral symmetrical hip contractures (Group 1). The asymmetrical pattern was related mainly to the presence of unilateral or unequal hip contractures. This study shows that gait assymetry can not be attributed only to the hip instability but seems to be more related to unequal hip contractures, thus gait symmetry could probably be achieved with the correction of the contractures involved, either by soft tissue or bone procedures.