No abstract

The development of dysplasia of the hip in cerebral palsy has been studied in 292 hips in children. The rate of migration of the hip has been defined, and gave a very early indication of the prognosis for the dysplasia. A close relationship was also found between the early radiographic changes and the functional locomotor anatomy. By reviewing the initial radiographs the need for early treatment and its adaptation to the future locomotor potential of the child can be assessed. Treatment is usually by musculotendinous releases and is especially effective in early recentering of the femoral head, but this method is ineffective in correcting bone dysplasia, particularly acetabular obliquity, which starts at around the age of 30 months. It is preferable to anticipate its development by early tenotomies which are much better tolerated than pelvic osteotomy in spastic children.

No abstract

No abstract

The clinical examination of the scoliotic child's profile shows that it does not correspond to the physiological curvatures. This three-dimensional study of scoliosis shows evidence of the existence of three components, frontal, sagittal, and axial. Each generates a pathological displacement of the vertebrae maximal at the apical vertebral level. Because of rotation, in order to analyze each of the components, radiographs must be taken along the frontal or sagittal plane of the vertebrae. A comparative study of the sagittal and frontal components during progression of scoliosis indicates that the apical vertebrae are displaced not only laterally but also forward and then backward. The apical vertebrae are situated anteriorly with respect to the end vertebrae. If the scoliotic curves progress, the apical vertebrae eventually become displaced backward. During this displacement at a given moment they are situated in the frontal plane of the child at the same level as the upper end vertebra; then they come to lie behind this if the scoliosis continues to progress. This explains why, when observed from the side, the appearance changes and passes through three successive stages, lordosis, flat back, and kyphosis.