To find factors affecting hip and femoral deformities in children with spastic cerebral palsy (CP) by comparing various clinical findings with imaging studies including plain radiography and computed tomography (CT) imaging.
Medical records of 709 children with spastic CP who underwent thorough baseline physical examination and functional assessment between 2 to 6 years old were retrospectively reviewed. Fifty-seven children (31 boys and 26 girls) who had both plain radiography of the hip and three-dimensional CT of the lower extremities at least 5 years after baseline examination were included in this study.
The mean age at physical examination was 3.6 years (SD=1.6; range, 2–5.2 years) and the duration of follow-up imaging after baseline examination was 68.4 months (SD=22.0; range, 60–124 months). The migration percentage correlated with motor impairment and the severity of hip adductor spasticity (R1 angle of hip abduction with knee flexion). The femoral neck and shaft angle correlated with the ambulation ability and severity of hip adductor spasticity (R1 and R2 angles of hip abduction with both knee flexion and extension).
Hip subluxation and coxa valga deformity correlated with both dynamic spasticity and shortening of hip adductor muscles. However, we found no correlation between femoral deformities such as femoral anteversion, coxa valga, and hip subluxation.
Citations
Lunate and perilunate dislocations are uncommon, but they have clinical importance because complications, such as median neuropathy and avascular necrosis of the lunate, can occur. Although early diagnosis enabling early surgical treatment is crucial for preventing long-term sequelae, these dislocations are frequently missed in the initial assessment. Imaging tools, such as plain radiography, magnetic resonance imaging, ultrasonography, and electrodiagnostic studies, have been used for diagnosis. The proper choice of initial evaluation tools is important for making an accurate early diagnosis. Here we present a case of lunate dislocation associated with median neuropathy in which ultrasonography, along with the electrodiagnostic study and plain radiography, played an important diagnostic role in detecting structural abnormalities. This case report reveals the complementary diagnostic role of ultrasonography in initial assessment and provides ultrasonographic images of lunate dislocation as a cause of median neuropathy.
The obturator nerve is originated in lumbar 2, 3, 4 roots and inserted at the inner muscle of thigh, by way of sacral ala and obturator foramen. In the case of pelvic surgery or obstetric trauma, the obturator neuropathy is occasionally occurred. However, the obturator neuropathy is rarely seen in the orthopedic accident.
In literature, one case of obturator neuropathy is reported after 2,012 cases of total hip replacement surgery. The useful diagnostic tools of obturator neuropathy are needle EMG on the obturater nerve innervated muscle, not conduction test on the nerve.
We report of a case of obturator neuropathy after closed reduction of posterior hip dislocation complicated by traffic accident with a brief reviewed of literatures.
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