Additionally, in a growing child, the discrepancy between the increasing length of the lower extremity and contracted ITB causes a progressive flexion and valgus deformity at the knee ( 4, 7, 8). The ITB occupies a plane lateral and anterior to that of the hip joint, and as such, a flexion and abduction hip deformity occurs, and for comfort, the hip is externally rotated. Yount ( 7) and Irwin ( 8) reported that the poliomyelitis-related ITB contracture is the greatest deforming factor in the lower extremity, resulting in an intractable sequela of the hip. SCI-related flaccid paralysis mimics the clinical features of poliomyelitis, and an iliotibial band (ITB) contracture is seen in both ( 5, 6). Especially when SCIs occur in the growing child, the challenges that arise are more problematic and differ from those experienced in adulthood a culmination of abnormal stress and strain exerted and the rapid changes in the architecture of the bones and joints debilitate the child, and a vicious cycle ensues ( 1– 4). Inhibited muscular actions and resultant muscle shortening cause myostatic contractures, which, along with neuromuscular imbalances, gravitational stresses, and prolonged shortened malposture, produce joint deformities ( 1). ![]() We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.įlaccid paralysis after spinal cord injuries (SCIs) may result in variable degrees of loss of function and progressive deformities of the spine and lower extremities. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up.Ĭonclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. Mean lumbar lordosis decreased ( p = 0.029) while the mean Cobb angle increased ( p = 0.001) at the latest follow up. Results: Improvements were seen in the mean hip flexion contracture ( p < 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries. 3Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South KoreaĪim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture.2Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.1Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.Isaac Rhee 1 Woo Sung Do 2 Kun-Bo Park 2 Byoung Kyu Park 3 Hyun Woo Kim 2 *
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