Keep them walking :  functional results of tendon transfers in MMC

Keep them walking : functional results of tendon transfers in MMC PowerPoint PPT Presentation


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Wilhelmina Children's Hospital Utrecht. Functional results of tendon transfers in MMC. Background:High incidence of foot abnormalities in MMC (1)Structural or secondary to muscle imbalanceAlthough reports about effects of tendon transfers in feet, no functional results according to ambulance (2,3

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Keep them walking : functional results of tendon transfers in MMC

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1. Wilhelmina Children’s Hospital Utrecht ‘Keep them walking!’: functional results of tendon transfers in MMC Besselaar AT Haverkamp A Sakkers RJB Castelein RM Pruijs JEH Wilhelmina Children’s Hospital Utrecht, The Netherlands

2. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC Background: High incidence of foot abnormalities in MMC (1) Structural or secondary to muscle imbalance Although reports about effects of tendon transfers in feet, no functional results according to ambulance (2,3)

3. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC Methods: Between 1985-2006 71 children with MMC and motor level beneath L2 L2 because there is a bad walking prognosis in higher lesion levels (4-9) In patients where at the end of FU, puberty was passed (?:13 yo, ?:14yo)

4. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC After inclusion criteria: 32 children selected Ambulance scored with Hoffer score (10) Baseline criteria see figure 1 Different tendon transfers

5. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC

6. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC Discussion Hydrocephalus is in literature important predicting factor concerning mobility (11,12) In our series also the case! No reports show relation tendon transfers-mobility (e.g. using Hoffer scores) although mobility is very important in MMC patients

7. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC Conclusions: In our series we show that tendon transfers beneath motor lesion level L3 have good effect on ambulance described by the Hoffer score. In patients with a hydrocephalus, the effect can be disappointing.

8. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC Literature: Broughton NS Graham G Menelaus MB The high incidence of foot deformity in patients with high-level spina bifida. JBJS B 1994;76:548-550 Frawley PA Broughton NS Menelaus MB Incidence and type of hindfoot deformities in patients with low-level spina bifida. J Pediatr Orthop. 1998 May-Jun;18(3):312-3 Fraser RK Hoffman EB Calcaneus deformity in th eambulant patient with myelomeningocele. JBJS B 1991 Nov;73(6):994-7 Swank M Dias L Myelomeningocele: a review of the orthopedic aspects of 206 patients treated from birth with no selection criteria. Dev Med Child Neurol. 1992 Dec;34(12):1047-52 McDonald CM Jaffe KM Mosca VS Shurtleff DB Ambulatory outcome of children with meningomyelocele: effect of lower-extremity muscle strength Dev med child neurol 1991 Jun:33(6):471-2 Bartonek A Saraste H Samuelsson L Skogg M Ambulation in patients with myelomeningocele: a 12-year follow-up J Pediatr Orthop. 1999 Mar-Apr;19(2):202-6 Diaz Llopis I et al Ambulation patients with meningomyelocele: a study of 1500 patients. Paraplegia 1993;31:28-32

9. Wilhelmina Children’s Hospital Utrecht Functional results of tendon transfers in MMC Literature Findley TW Agre JC Schmalz R Birkehak RR McNally MC Ambulation in the adolescent with myelomeningocele. I: Early childhood predictors 1 Arch Phys Med Rehabil. 1987 Aug;68(8):518-22. Swank M Dias LS Walking ability in spina bifida patients a model for predicting future ambulatory status based on sitting balance and motor level. J Pediatr Orthop. 1994 Nov-Dec;14(6):715-8. Hoffer MM Feiwell E Perry R Perry J Bonnet C Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am. 1973 Jan;55(1):137-48 Verhoef M Bart HA Post MW van Asbeck FW Gooskens RH Prevo AJ Secondary impairments in young adults with spina bifida and hydrocephalus Dev Med Child Neurol. 2004 Jun;46(6):420-7 Cate ten IM Kennedy C Stevenson J Disability and quality of life in spina bifida and hydrocephalus. Dev Med Child Neurol. 2002 May;44(5):317-22

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