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

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.

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

“…The lack of outcomes studies on this subject is related to the complexity of many patients with MMC and the difficulty in designing clinical trials because of the overall decrease in the prevalence of MMC in most industrialized countries. 2,3 The rarity of MMC could cause physicians to encounter it less often, consequently promoting less research and a lack of interest in this disease. Moreover, funds for research are likely more available for more prevalent diseases and many hurdles are inherent in multi-centered, randomized clinical trials for pediatric diseases.…”

“…[54][55][56][57][58] Swaroop and Dias argue that for sacral patients who can walk without support, hip dislocation could cause an asymmetric gait, and because gluteus lurch is quite significant with a loss of fulcrum, they suggest that in such cases, surgical relocation of hip could be considered. 3,57,59 However, this topic has not been addressed currently by any other studies. 3,59 According to Wright, surgical treatment in children with a neurological level below L4 and with unilateral hip dislocation suffering a decline in walking ability might benefit from surgical treatment.…”

“…3,57,59 However, this topic has not been addressed currently by any other studies. 3,59 According to Wright, surgical treatment in children with a neurological level below L4 and with unilateral hip dislocation suffering a decline in walking ability might benefit from surgical treatment. However, whether surgery improves function in these patients cannot be determined from the literature.…”

Spina Bifida and Rehabilitation

“…This group can be divided into two subgroups: upper and lower sacral. While patients with upper sacral lesions can walk with AFO or foot orthoses, patients with lower sacral lesions can walk without an orthosis (1,27,38).…”

“…These make the use of orthoses and shoes more difficult and can cause compression wounds by negatively affecting ambulation. These deformities can be avoided by positioning, orthoses, and surgical intervention, when necessary (38). Another complication encountered in patients with SB is osteoporosis and related fractures.…”