Computerized motion analysis, through innovation in technology and data interpretation, can be used as an important clinical tool. Gait deviations commonly occur in the pediatric population, some of which require a comprehensive approach to evaluation and treatment. This article provides an overview of the clinical application of gait analysis in pediatric orthopedics. The patient populations that may benefit from gait analysis and common gait abnormalities are presented as well as a systematic approach to observational gait analysis. The application of gait analysis in quantitatively identifying gait deviations and assisting with clinical decision-making are reviewed. Major components of the testing protocol such as physical examination, three-dimensional kinematics and kinetics, foot pressure, electromyography, energy consumption, are described. Principles of patient management and the utilization of gait analysis in various stages of clinical evaluation and treatment planning (baseline, follow-up, pre-intervention and post-interventions) are discussed. Two example cases (in-toeing and cerebral palsy) are illustrated to demonstrate the use of gait analysis in forming a therapeutic plan and measuring the treatment outcome quantitatively. Supplemental video files are included to illustrate important components of computerized gait analysis, demonstrate abnormal gait patterns, and present preoperative and postoperative gait videos of the case studies.
Most cases of scoliosis are diagnosed and treated during adolescence; many are detected in school screening programs. For a small percentage of children, however, the onset of scoliosis occurs much earlier than adolescence.Infantile scoliosis (ie, onset from birth to two years of age) and juvenile scoliosis (ie, onset from three to nine years of age) involve very different diagnoses and treatment regimens than adolescent scoliosis. Early onset scoliosis may resolve with growth or may require nonsurgical treatment (eg, orthosis, body cast); surgical intervention (eg, halo traction, growing rods, vertical expandable prosthetic titanium rib); or a combination of both.
Early-onset scoliosis presents at birth and up to five years of age. Growing rods are a treatment option when early-onset scoliosis cannot be controlled by serial casts or braces. The function of a growing rod is to allow a child's spine to continue to grow under controlled conditions until a definitive correction can be made when the patient nears skeletal maturity. This article presents two case reports describing the use of an expandable magnetic growing rod in children with progressive, early-onset scoliosis. After implantation, caregivers expand the rod nonsurgically using an external magnet to obtain and maintain correction while the child grows. The first case report describes the use of a magnetic growing rod in a patient with a rigid spinal curve and a significant rotational deformity; the second case report describes a patient with a more flexible neuromuscular curve. These were the first two patients to be offered treatment with an expandable rod in North America after the surgeon obtained approval to use the device based on compassionate grounds from the US Food and Drug Administration and institutional review board consent and approval for both surgeries.
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