Do Not Do this Case Report: Recurrence of Knee Flexion Contracture after Extension Osteotomy in Congenital Patellar Dislocation: The Importance of a Thorough Patient Evaluation

2020 ◽  
Author(s):  
Soroush Baghdadi ◽  
Taghi Baghdadi
Keyword(s):  
Cerebral Palsy ◽  
Case Report ◽  
Knee Flexion ◽  
Patellar Dislocation ◽  
Gait Pattern ◽  
Flexion Contracture ◽  
Tibial Rotation ◽  
Patient Evaluation ◽  
Second Surgery ◽  
Crouch Gait

Background: Congenital patellar dislocation (CPD) is a rare disorder which presents with hypoplastic and irreducible patellae. It is accompanied by flexion contracture of the knee joint, genu valgum, and external tibial rotation. Case Report: A seven-year-old girl with CPD who was misdiagnosed as having cerebral palsy (CP) crouch gait and underwent distal femoral extension osteotomy (DFEO) without paying attention to the dislocated patellae, is presented. Recurrence ensued, and the patient was referred for further evaluation. After a second surgery to address the dislocated patellae, the flexion contracture and gait pattern improved significantly. Conclusion: The case underscores the importance of a systematic, thorough physical examination, without which uncommon diagnoses will be overlooked, exposing the patient to further morbidity and complications.

scholarly journals The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Evelina Pantzar-Castilla ◽  
Brian Po-Jung Chen ◽  
Freeman Miller ◽  
Jacques Riad
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Short Term ◽  
Knee Flexion Contracture ◽  
Group 2 ◽  
Group 1

Abstract Background Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Methods Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Results Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Conclusions Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

Dose-dependent Changes in Gait Pattern after Intrathecal Baclofen Bolus Injection in Adult Ambulatory Cerebral Palsy: A Case Report

2015 ◽  
Vol 8 (2) ◽  
pp. 104
Author(s):  
Yoon-Kyum Shin ◽  
Ae Ryung Kim ◽  
Jin Woo Chang ◽  
Won Seok Chang ◽  
Don Shin Lee ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Case Report ◽  
Bolus Injection ◽  
Intrathecal Baclofen ◽  
Gait Pattern ◽  
Dose Dependent

scholarly journals Preaxial longitudinal intercalary radial hemimelia in a dog: a case report

2012 ◽  
Vol 51 (No. 3) ◽  
pp. 118-123
Author(s):  
Alam MR ◽  
Heo SY ◽  
Lee HB ◽  
Kim JH ◽  
Park YJ ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Distal Portion ◽  
Flexion Contracture ◽  
Medical Centre ◽  
Bone Plate ◽  
Intact Male ◽  
Second Surgery ◽  
Surgical Corrections

A 9-month-old 10 kg intact male crossbred dog was admitted to The Animal Medical Centre,ChonbukNationalUniversitywith congenitally malformed right forelimb. Physical exanimation of the limb showed varus deviation of the forepaw and flexion contracture of the interphalangeal joints. The survey radiographs revealed complete absence of the radius, poor congruency of the humeroulnar joint and 90° varus deviation of the ulnocarpal joint. A preaxial longitudinal intercalary radial hemimelia was diagnosed and the dog underwent 3 surgeries for correction of the deformity. During the first surgery, olecranon osteotomy and arthrodesis of the elbow were performed. Three months later, a second surgery was done to perform carpal panarthrodesis using bone plate and screws which was unsuccessful. Two weeks after, with a third surgery carpal arthrodesis was performed using acrylic frame, the distal portion of limb was straightened and the residual deviation of the forepaw was corrected. The surgical corrections resulted in satisfactory use of the limb and a better quality of life.

CASE REPORT: Juvenile Dermatomyositis with Bilateral Progressive Knee Flexion Contracture

2007 ◽  
Vol 464 ◽  
pp. 238-241 ◽  
Author(s):  
Melih Guven ◽  
Purushottam A Gholve ◽  
Arkady Blyakher ◽  
Roger F Widmann
Keyword(s):  
Case Report ◽  
Knee Flexion ◽  
Juvenile Dermatomyositis ◽  
Flexion Contracture ◽  
Knee Flexion Contracture

scholarly journals Physics-based predictive simulations to explore the differential effects of motor control and musculoskeletal deficits on gait dysfunction in cerebral palsy: a retrospective case study

2019 ◽  
Author(s):  
Antoine Falisse ◽  
Lorenzo Pitto ◽  
Hans Kainz ◽  
Hoa Hoang ◽  
Mariska Wesseling ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Muscle Activity ◽  
Clinical Decision Making ◽  
Neuromuscular Control ◽  
Gait Pattern ◽  
Retrospective Case ◽  
Crouch Gait ◽  
Walking Performance ◽  
Tendon Properties ◽  
Predictive Simulations

ABSTRACTModel-based simulations of walking have the theoretical potential to support clinical decision making by predicting the functional outcome of treatments in terms of walking performance. Yet before using such simulations in clinical practice, their ability to identify the main treatment targets in specific patients needs to be demonstrated. In this study, we generated predictive simulations of walking with a medical imaging based neuro-musculoskeletal model of a child with cerebral palsy presenting crouch gait. We explored the influence of altered muscle-tendon properties, reduced neuromuscular control complexity, and spasticity on gait function in terms of joint kinematics, kinetics, muscle activity, and metabolic cost of transport. We modeled altered muscle-tendon properties by personalizing Hill-type muscle-tendon parameters based on data collected during functional movements, simpler neuromuscular control by reducing the number of independent muscle synergies, and spasticity through delayed muscle activity feedback from muscle force and force rate. Our simulations revealed that, in the presence of aberrant musculoskeletal geometries, altered muscle-tendon properties rather than reduced neuromuscular control complexity and spasticity were the primary cause of the crouch gait pattern observed for this child, which is in agreement with the clinical examination. These results suggest that muscle-tendon properties should be the primary target of interventions aiming to restore a more upright gait pattern for this child. This suggestion is in line with the gait analysis following muscle-tendon property and bone deformity corrections. The ability of our simulations to distinguish the contribution of different impairments on walking performance opens the door for identifying targeted treatment strategies with the aim of designing optimized interventions for neuro-musculoskeletal disorders.

scholarly journals A new tendon-lengthening technique using a tendon stripper for knee flexion contracture in a cerebral palsy patient

2020 ◽  
Vol 18 ◽  
pp. 110-112
Author(s):  
Shogo Nakagawa ◽  
Hirotaka Mutsuzaki ◽  
Yuki Mataki ◽  
Ryoko Takeuchi ◽  
Hiroshi Kamada
Keyword(s):  
Cerebral Palsy ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Tendon Lengthening ◽  
Cerebral Palsy Patient
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