Diversities.of.neck4shaft.angle.of.proximal.femur.in.patients.with. spinа bifida
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1 Diversities.of.neck4shaft.angle.of.proximal.femur.in.patients.with. spinа bifida Ivanov S.V.,.Baindurashvili A.G.,.Kenis V.M. Turner.Scientific.and.Research.Institute.for.Children's.Orthopedics.(Saint4Petersburg,.Russia). Does¬&intend&to&discuss&commercial&products&or&services. Does¬&intend&to&discuss&non4FDA&approved&uses&of&products/providers&of&services. Discloses&a&financial&relationship&with&Merck&Pharmaceuticals&speaker&honorarium&related&to&Doctor4Patient&relationship.
2 Sharrаrd,.
3 The.aim.of.the.study Assess&the&diversity&of&neck4shaft&angle&of&proximal&femur&in&children&with& spina bifida
4 414 children&with&spina bifida&were& examined&during&the&period&of& years Exclusion.criteria: Materials.and.methods
5 Levels&of&muscle&function&by&Sharrаrd Level Muscle.power Neurosegmental level 1 Weakness&of&intrinsic&foot&muscles& Good4to4normal&foot&plantar flexion&(grade&4 5)& S2 2 Fair&or&less&foot&plantar flexion&(grade 3)&Fair&or&better&knee&flexion& (grade& &3)&Poor&to&fair&or&better&hip&extension&and/or&hip&abduction& (grade& &2 3)& 3 Good4to4normal&hip&flexion&and&knee&extension&(grade&4 5)&Fair&or& less&knee&flexion&(grade& &3)&Trace&of&hip&extension,&hip&abduction,& and&below4knee&muscles& 4 No&knee&extension&activity&Poor&or&less&hip&flexion&(grade& &2)&Fair&or& good&pelvic&elevation& 5 No&muscle&activity&in&the&lower&limbsU&No&pelvic&elevation& S1 L5 L4 L3 L2 L1 Thoracic
6 Function&levels&by Mark&Hoffer&criteria&(1973) 1 level Community ambulator 2 level Household ambulator 3 level Non-function ambulator 4 level Non - ambulator
7
8 NSA&according&to&age&in&patient&with&SB Normal&NSA NSA&in&patient&with&SB Age&346 Age&7410 Age& Age& M.&B.&Dobbs&and&J.&A.&Morcuende, Other&Condition&of&the&Hip &1986
9 828&hips&in&patients&with&spina bifida normal&nsa&4 126&(15,2%) Increased&neck4shaft&angle&(coxa valga)& 678&(82%) decreased&neck4shaft&angle&(coxa vara)&4 24&(2,8%) Normal 15,8% Coxa vara 2,8% Coxa& valga 82%
10 NSA&according&to&neurosegmental level NSA NSA Thoracic L14L2 L34L4 L54S1 S2
11 NSA&according&to&function&levels NSA Non&4 ambulator Non&4 function& ambulator Household& ambulator Community& ambulator NSA
12 Patients&with&neurosegmental level&l54s1& 19 patients with L5-S1 neurosegmental levels, non functional ambulators 23 patients with L5-S1 neurosegmental levels, household ambulators NSA First&group& second&group NSA
13 Femoral&Neck&Abnormalities& In&24&(2,8%)&hips& decreased neck4shaft& angle.&
14 Femoral&Neck&Abnormalities& Type А widening'of'physis and'varus deformity Тype В narrowing' of'the'femoral'neck, resulting'in'a'typical'mushroom' appearance
15 Proximal&femur& mushroom&appearance& narrow&valgus&neck&
16 I 28 THE JOURNAL OF BONE AND JOINT SURGERY COXA VARA IN SPINA BIFIDA H. WEISL Royal Infirmary, From the Card yef can develop either the well-known coxa In spina bifida the femoral neck valga or the hitherto unreported vara. Twenty-three cases of coxa vara spina bifida are reported. These result from spontaneous coxa in separation of the upper femoral epiphysis (10 cases), spontaneous fracture of the femoral neck (three cases) and iatrogenic avascular necrosis of the upper femoral epiphysis (10 cases). 3&types&according&to&Weisl classification:& In Cardiff 6 12 children have been registered with the Spina Bifida Unit and these 338 still attend regularly of for supervision. part of this supervision intravenous As pyelograms carried out and these radiographs are also show the hips and the proximal femora. As one would expect, the films show examples of all the well-known neurogenic lesions of coxa valga, subluxation and life-as long as the epiphysis remained open. All the patients had either thoracolumbar or high lumbar lesions on the affected side. No child born with a separated was epiphysis and the earliest onset was at the age of six months. When the condition developed during the first two or three years of life the separation was followed by radiological union of the separated epiphysis, producing 1)'spontaneous'separation'of'upper'femoral'epiphysis:' 2)'spontaneous'fractures'of'the'neck'of'the'femur:' Case 1 Figure 1--The early stages of spontaneous epiphysial separation : the loss of definition of the epiphysis, widening of space between the epiphysis and metaphysis and irregularity of the proximal metaphysis. the the the Figure later stage showing the progressive development coxa vara. Figure final situation of healing 2-A of 3-The and coxa vara. 3)'iatrogenic'avascular'necrosis'of'upper'femoral'epiphysis.' dislocation of the hip. However, three other lesions, not previously described detail, have come to light these in : are 10 cases of spontaneous separation of the upper femoral epiphysis, three spontaneous fractures of the neck femur 10 examples ofiatrog nic avascular ofthe and necrosis of the upper femoral epiphysis. As these conditions heal they all produce coxa vara. a CASE REPORTS Spontaneous separation of the upper femoral epiphysis Spontaneous separation of the upper femoral epiphysis was observed in 10 patients (Table I). The condition affected children during the whole the first decade of of H. Weisl, MD, MChOrth, FRCS, Consultant in Orthopaedic and Traumatic Surgery Royal Infirmary, Cardiff, Glamorgan, South Wales British Editorial Society of Bone Joint and Surgery X/83/2022-0l 28 $2.00 a coxa vara ; the consequent shortening did not impair the limited locomotion of children. This is illustrated the by Case 1. Case 1. This patient was born with a motor level at Ll on the right and L3-4 on the left ; hips were normal at birth. At the age of six months the the right epiphysial plate became widened, the metaphysis became irregular and a varus deformity developed 1). Four years later the (Fig. femoral neck had partially ossified and upper femoral epiphysis was the abnormal in shape (Fig. 2), and finally at the of years the coxa age 10 vara was fully developed, the right upper femoral epiphysis had closed and the left epiphysial plate had almost closed (Fig. 3). child has This five centimetres of shortening and walks with calipers and a raised true boot. In older children the separated epiphysis did not ; despite this the affected hips not significantly unite were unstable and the caliper-users were able to continue to use their appliances. Case 6. This patient had motor function to Ll. The hips remained normal until the age of three and half Radiographs that time a years. at showed widening of the epiphysial plate and absorption the neck of of
17 Coxa&vara paralitica The&radiographs&of&patient&L.,&Spina bifidau&thoracic&neurolosegmental levelu& Coxa vara paralitica bilateralis.&a.&at&age&of&2&yearsu&b.&10&yearsu&c.&ct4scan&at&10&years.
18 Coxa&vara paralitica The&radiographs&of&patient&B.,&diagnosis:&spina bifidau&neurosegmental level&l14l2u Coxa vara paralitica bilateralis as&the&results&of&fracture&of&&the&femoral&neck.& A.& at&the&age&of&7u&b.& 10&years
19 Coxa&vara paralitica The&radiographs&of&patient&S.,&4&yearsU&diagnosis:&spina bifidau&neurosegmental level&l34l4u& bilateral&dislocation&of&the&hipu&coxa vara paralitica bilateralis as&the&result&of&avascular&necrosis& of&femur&head.& A& x4ray&of&the&hip&joints&in&anteroposterior projection&& B&4 arthropneumo(roentgeno)grammes in&anterior4posterior&plane C&4 arthropneumo(roentgeno)grammes in&lauenstein& plane.&the&&«two4humped»&femur&head& bilateral.
20 Conclusions NSA'in'children'with'SB'has'wide'range'of'variations'with'tendency'to'coxa valga in'the'majority'of'patients AgeDmatched'NSA'correlates'with'neurosegmental level:'ambulatory'status'in' walking'children'doesn t'influence'nsa'directly Coxa'vara is'relatively'rare'variant'of'deformity'in'children'with'sb'which' should'be'taken'into'account'for'differential'diagnostics'and'management'to' avoid'unnecessary'treatment
21
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