Eugene E. Bleck

Radiographic determination of lordosis and kyphosis in normal and scoliotic children.

We conducted a radiographic retrospective study in children to determine spinal lordosis and kyphosis. A total of 218 lateral standing full-length radiographs were studied: 104 normal and 114 scoliotic patients. Normal X-ray films were defined as those obtained for suspected disorder (e.g., scoliosis) with no abnormalities detected by the radiologist or orthopedist. Thoracic kyphosis is defined as the angle between perpendiculars drawn from the inferior endplate of T5, and the superior endplate of T12. Lordosis is the angle between perpendiculars from the inferior endplate of L1 and the superior endplate of L5. The angle between the inferior endplate of L5 and the top of the sacrum is the L5–S1 angle. Statistical analysis was undertaken to compare lordosis and kyphosis radiographic measurements with age, sex, height, and weight employing the SAS package program. No significant relationships were noted between degree of scoliosis, age, sex, height or weight, and kyphosis, lordosis, or L5–S1 angle. Neither could correlations among the three radiographic measurements be made. Lordosis measured 40° (range 31–49.5°) in normal and 48.5° (range 40–55°) in scoliotic patients. Kyphosis measured 27° (range 21–33°) in normal and 28° (range 16.5–36°) in scoliotic patients.

Locomotor Prognosis in Cerebral Palsy

A study of the prognosis for walking of 73 pre‐school children who had cerebral palsy or delayed motor development is reported. The importance of prognostic signs, based upon the presence or absence of postural reflex activity, was confirmed. The prognosis was accurate in 94‐5 per cent of the 73 children studied.

Management of the motor disorders of children with cerebral palsy

Foreword Martin Bax and David Scrutton 1. The familys needs: coordination of care and the management team Peter Rosenbaum 2. The types of cerebral palsy 3. Multidisciplinary Roslyn Boyd 4. Goal setting and outcome measures Eva Bower 5. Global therapeutic approaches and the evolving role of physical therapy Margaret Mayston 6. Learning and neural plasticity Mary Galea 7. Focussed therapeutic approaches Diane Damiano 8. Mechanisms of deformity H. K. Graham 9. Prevention of deformity Aidan Cosgrove 10. Treatment and management of hypertonia Jean-Pierre Lin 11. Transition to adulthood Sue Edwards 12. Prospects for the future Murray Goldstein Index.

Metatarsus adductus: classification and relationship to outcomes of treatment.

In a retrospective study of results of treatment in 160 children (265 feet) who had metatarsus adductus prospectively defined by severity and flexibility, we found that in 147 patients treated with plaster casts or casts followed by derotation splints the only significant predictor of a good outcome was the age of the patient. Results were statistically significantly better when treatment was begun from ages 1 day to 8 months. No significant correlations with poor results were found using the severity and flexibility grading systems. Given the public attitude toward deformity, it seems wiser to treat in infancy those feet graded “moderate” or “severe.” If treatment is not commenced until the child is old enough to preclude conservative treatment, extensive surgery will be necessary to correct a “severe” deformity.

Segmentai Instrumentation Without Fusion in Children With Progressive Scoliosis

Nine young children had segmentai spinal stabilization without fusion for progressive scoliosis. External bracing was not used. There were no immediate complications, but at a mean follow-up of 28 months, the mean loss of correction was 32% and only four patients maintained the initial correction. The mean interval spinal growth was only 0.8 cm. Rods failed in three patients, requiring revision and fusion. Thus, the early results of this technique are discouraging.

Surgical Correction of Equinus Deformity in Cerebral Palsy

Sixty‐seven children who had been operated on for equinus deformity due to spastic cerebral palsy were studied retrospectively. The recurrence rate of equinus after 51 Baker‐Strayer gastrocnemius lengthenings was 29 per cent, and after the sliding Hoke type of tendo calcaneus lengthenings it was 9 per cent. In both groups the postoperative care was the same: no bracing, no night splints, and no stretching. The recurrence rate of equinus after tendo calcaneus lengthening is comparable with other reported series.

Augmented Auditory Feedback in the Treatment of Equinus Gait in Children

This study is a report on the treatment of dynamic equinus in children with cerebral palsy or idiopathic toe‐walking, by means of auditory augmented feedback. The initial results (after three months) showed improvement in every case, and in four patients with longer follow‐up improvement appeared to be maintained or continued, although at a reduced pace. This treatment method is recommended only for children over the age of four years who are independently ambulatory, who have a range of ankle dorsiflexion to neutral or beyond with the knee extended, and who have a supportive and co‐operative family.

Non-union of fractures in children who have osteogenesis imperfecta.

Although a fracture rarely fails to unite in a healthy child, non-union is not a rare occurrence in a child who has osteogenesis imperfecta. We identified twelve non-unions in ten patients from a population of fifty-two patients who had osteogenesis imperfecta. The average age of these patients when the diagnosis of non-union was made nine years, and the average age at the time of treatment was 12.5 years. All of the patients had had a decrease in functional ability as a result of the non-union. There were five femoral, four humeral, one radial, one ulnar, and one pubic non-union. Five of the non-unions were hypertrophic, and seven were atrophic. Eight of the nine ununited fractures that were operated on healed after excision of the non-union, intramedullary nailing, and bone-grafting. Three of the non-unions (in two patients) were not operated on, and the one patient in whom surgery failed had an amputation. Non-union was frequently associated with repeated fractures at a progressively deforming site.

Gait Electromyography in Normal and Spastic Children, with Special Reference to Quadriceps Femoris and Hamstring Muscles

Telemetered gait electromyography was used to investigate gait patterns and the phasic behavior of the quadriceps femoris and medial hamstring muscles in 26 normal children and 32 children with spastic cerebral palsy.

Persistent Medial Deviation of the Neck of the Talus: A Common Cause of In-Toeing in Children

We studied I 17 in-toed children and found external tibial-fibular torsion and internal axial deviation of the foot from the mids;igittal plane. Based on studies of newborn infants, radiographs. and anatomical specimens. we concluded that ii major couse of in-toed gait in children wiis persistence of the fetid medial deviation of the talur neck and not internal tibial torsion. Spontaneous correction can be anticipated in children up to the age of 3 years if the internal axial rotation is less than 10%. If it is greater than 10%, prognosis for correction with urthoses is age related. In children over the age of 6 years, little correction seems possible.