For those who perform infant hip ultrasounds, there has always been the issue of measurement as part of the sonographic assessment. The 2013 American Institute of Ultrasound in Medicine (AIUM) practice parameter states: "Validation by angle and femoral head coverage measurement is optional" [1]. The "Graf" followers have subscribed to the tables of alpha and beta angles and find publications illustrating their use and results [2,3]. Those who do not wish to use angles and rely on the "Dynamic (Harcke)" technique for position and stability [4,5] have other criteria for acetabular development [6]. Our group directed attention to the coverage of the femoral head by the bony acetabulum [7] as well as to the slope and configuration of the iliac bone. As a consequence, we are referenced as the source of the 50% rule: "In a normal hip, the acetabulum should cover 50% (one half or more) of the femoral head." While we have not discouraged the use of this guideline, we have not formally published it as dictum. This review seeks to clarify the rule, present data that support its use, and note pitfalls that can occur with its application. As a caveat, this discussion assumes that when reference is made to a coronal sonogram, whether the hip is extended (neutral) or flexed, the image correctly shows: (1) a straight iliac line, (2) the junction of the iliac bone and tri-radiate cartilage and (3) the echogenic tip of the labrum.Early in the development of hip ultrasound, there was a need to establish its validity in comparison with established techniques like the pelvic radiograph. For acetabular development, the radiographic "acetabular index (angle)" was, and still is, the gold standard. In our quest to validate the coronal flexion sonogram as a reflection of acetabular development, we enlisted Christian Morin, a pediatric orthopedic fellow from France, to compare femoral head coverage as seen by sonogram with a standard pelvic radiograph obtained at the same time. It is important to note the ultrasound technology of the time (1984) was the mechanical sector transducer, which showed a curved configuration of the iliac bone and had less resolution. Comparing bony acetabular depth (d) with the diameter of the cartilaginous femoral head (D) produced a fraction easily converted to a percentage. When comparing percentage of coverage with measure of acetabular angle, we found that 58% or greater coverage always correlated with an accepted normal value. Similarly, coverage of less than 33% always reflected an abnormal radiographic acetabular angle [7]. Many of our sonograms fell in the 33-58% coverage range, where the radiograph measure could be either normal or abnormal. Terjesen et al.[8] also compared radiography and ultrasound using a measure of acetabular coverage called "bony roof %." This measure used different landmarks on a coronal neutral view and found some cases with normal ultrasound and dysplasia by radiographic index [8].When sonography transitioned to linear-array transducers, thereby achieving better resolution a...
Level IV-prognostic case series.
Background Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children's Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication. Case Description We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery. Literature Review Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motorevoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit. Clinical Relevance Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.
Objective. The aim of this study was to assess the effectiveness of a 3-week rehabilitation programme focusing only on the cervical region, pain intensity, range of motion in the cervical spine, head posture, and temporomandibular joint (TMJ) functioning in subjects with idiopathic neck pain who did not report TMJ pain. Design. A parallel group trial with follow-up. Methods. The study included 60 participants divided into 2 groups: experimental: n = 25 , 27-57 years old, experiencing idiopathic neck pain and who underwent a 3-week rehabilitation programme, and the control, n = 35 , 27-47 years, who were cervical pain-free. At baseline and after 3 weeks of treatment in the experimental group and with a 3-week time interval in the control group, pain intensity, head posture in the sagittal plane, range of motion in the cervical spine, and TMJ functioning were evaluated. Results. After 3 weeks of rehabilitation, there was a significant decrease in pain intensity, improved range of motion of the cervical spine and head posture, and improved clinical condition of TMJ in participants with idiopathic neck pain who did not report TMJ pain. Conclusion. The study suggested that idiopathic neck pain is associated with limited range of motion in the cervical spine, incorrect head posture, and TMJ dysfunction. Our data suggests that therapy focusing only on the cervical region may improve the clinical condition of the TMJ in subjects with idiopathic neck pain who do not report TMJ pain. These observations could be helpful in physiotherapeutic treatment of neck and craniofacial area dysfunctions. This trial is registered with ISRCTN Registry ISRCTN14511735.
The aim of the study was to evaluate pelvic floor muscle bioelectrical activity in healthy, young, and nulliparous women, and to present normative values for all phases and parameters measured with the Glazer Protocol. In this study, 96 healthy, young, nulliparous women (age 22–27 years; 168.6 ± 5.1 cm; 57.1 ± 11.8 kg) were tested. The bioelectrical activity of the pelvic floor muscles was collected using an endovaginal electrode with the Glazer Protocol, which included the following series of muscles contractions and relaxations: pre-baseline rest, phasic contractions, tonic contractions, isometric contractions for muscle endurance evaluation, and post-baseline rest. The following normative values of the bioelectrical signal for all phases of the Glazer Protocol were calculated: mean, minimal, and maximal values, 95% confidence interval, standard deviation, 95% standard deviation confidence interval, variance, coefficient of variation, and standard error of measurement. Average Mean Amplitude (μV) was as follows: pre-baseline rest (6.26 ± 3.33 μV), phasic contractions (49.76 ± 26.44 μV), tonic contractions (37.05 ± 25.99 μV), endurance contraction (16.10 ± 6.68 μV), and post-baseline rest (6.93 ± 3.99 μV). This study was the first in which normative values for all phases of the Glazer Protocol were reported. This protocol is very often used in electromyography devices as a tool for pelvic floor muscle assessment. Due to the fact that the interpretation of the pelvic floor muscle evaluation is complex and difficult, the authors believe that the normative values proposed in this study allow for comprehensive interpretation of this test (both qualitatively and quantitatively) and provide a reference point for parameters measured in women with different pelvic floor dysfunctions.
The effect of a continuous intrathecal infusion of baclofen (CITB) was retrospectively studied in 19 ambulatory children with cerebral palsy (aged 12.4±4.9 years at CITB initiation). The mean clinical follow-up was 5.1±2.4 years and the mean follow-up gait analysis was 2.8±1.9 years. Spastic cerebral palsy diagnosis [14 (74%)] was most frequent. Most patients [11 (58%)] were Gross Motor Function Classification System level III. CITB significantly improved muscle tone and knee flexion at initial contact (P<0.05), but it did not lead to improved gait speed or gross motor function.
BackgroundThe natural history of hip instability (without subluxation or dislocation) and treatment in infants remain controversial. We performed a retrospective cohort case-only study with blinded, prospectively collected data to assess normalization of the acetabular index in consecutive untreated infant hips with sonography instability.MethodsConsecutive hips meeting inclusion criteria were followed by sonography/radiography and data analyzed using tabular and regression models.ResultsIn 48 hips, acetabular index measured by radiography normalized within 3 years of age without treatment. Normalization by age occurred: 7 months in 35%, 12 months in 67%, 18 months in 75%, 24 months in 81%, and 36 months in 100%. Two patterns of normalization of the acetabular index were observed: group I showed ossification in a physiological range of normal by 7 months of age, and group II had delayed ossification with later normalization of the acetabular index measurement. Breech presentation (p =0.013) and cesarean delivery (p =0.004) statistically directly correlated with a later normalization.ConclusionsThe natural history of infant hip instability (without subluxation or dislocation), which is reduced at rest and unstable with stress as diagnosed by the Harcke method of sonography, has spontaneous normalization of the acetabular index within 3 years of age. We suggest three patterns of acetabular ossification in unstable infants’ hips: (I) normal ossification, (II) delayed ossification with normalization of the acetabular index by age 3 years, and (III) defective secondary centers of ossification with an upward tilt of the lateral acetabular rim in adolescence.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-355) contains supplementary material, which is available to authorized users.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.