Iliopsoas transfer in cerebral palsy: the long-term outcome.

Thirty-three patients with cerebral palsy had iliopsoas transfers as part of their surgery for hip instability. All had total-body involvement, spastic cerebral palsy and none could walk. At the time of surgery, eight hips were subluxated and 39 were dislocated or severely subluxated. Mean follow-up was 8 years in patients between 8-25 years old. Forty-five of the 47 hips were located. Thirty patients had an accompanying scoliosis, and, in 10 patients, the rib cage impinged on the pelvis. Hip flexion had decreased in most patients. Sitting ability had not improved in any patient, and had in fact deteriorated in 50%.

Radiocolloids in the management of hemophilic arthropathy in children and adolescents.

Radiocolloids have been used in the treatment of hemophilic arthropathy. Fifty-eight joints of 35 patients were injected with 2-5 mCi of yttrium-90 silicate under local anesthesia. A preinjection arthrogram was performed to ensure correct placement of the needle. Plaster of paris cast immobilization of the joint was used for three days. After a mean follow-up period of seven years (range, two to 12 years), 47 joints were pain free, and 13 joints had not experienced another hemorrhagic episode. The mean hemorrhagic frequency had decreased from four per month to two per year. The radiation risk was far outweighed by the benefits of the procedure. Forty-seven of the 58 joints were rated as improved by the patients. The roentgenographic appearance of the joints had changed little. Only five complications occurred: three needle-track necroses because of extravasation of the radiocolloid, two severely painful joints immediately after injection, and one massive hemorrhagic episode. This form of treatment is suggested for hemophiliacs who have failed to respond to intensive physical and hematologic therapy, and for those patients who have inhibitors.

Irritable hip and Perthes' disease.

One hundred fifty patients with 160 irritable hip episodes and 120 patients with Perthes' disease who were treated between 1976 and 1986 were compared. The ratio of males to females was 2.1:1 for patients with irritable hip and 3:1 for patients with Perthes' disease. On the average, patients with irritable hip were aged 3 years and patients with Perthes' disease were aged 7 years. The duration of symptoms in patients with irritable hip averaged 6 days and 6 weeks in patients with Perthes' disease. One patient developed Perthes' disease 2 months after the irritable hip episode. The mean intraarticular pressure in 10 of the hip patients was 17 mm Hg in the neutral flexion/extension position. The pressure decreased to a mean of 7 mm Hg at 90 degrees of flexion and increased to 10 mm Hg at 45 degrees and to 16 mm Hg at 30 degrees of flexion. There was a positive correlation between the amount of aspirated fluid and recorded intracapsular pressure. Pressure tamponade in the irritable hip syndrome is probably not responsible for Perthes' disease.

Seat insert for cerebral-palsied children with total body involvement.

The sitting problems of cerebral-palsied children with total body involvement are discussed. A moulded seat-insert has been devised which resolves most of these problems. Custom-made for each child, the insert incorporates a head-support and the seat components are connected by hinges to allow some range of movement.

Progressive valgus deformity after juxta-epiphyseal fractures of the upper tibia in children.

Four cases of progressive valgus deformity following a juxta-epiphyseal fracture of the proximal end of the tibia are presented. We suggest that the deformity is due to asymmetrical growth of the physis. Since this type of fracture tends to create a deformity, an anatomical or even overcorrected reduction is required. Long follow-up is necessary.

Osteonecrosis following renal transplantation.

Subarticular osteonecrosis has been described with increasing frequency after renal transplantation and the use of immunosuppressive corticosteroids. Six cases have been encountered among 170 patients in the Johannesburg renal transplantation programme. The commonly affected sites are the femoral head, the femoral condyles, the humeral head, the talus and the capitulum. The radiological and morbid anatomical features of this complication are described, alternative theories of pathogenesis are considered and an approach to treatment is outlined.