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The Journal of Bone and Joint Surgery 80:1068-82 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Treatment of Hip and Knee Problems in Myelomeningocele*{dagger}

WALTER B. GREENE, M.D.{ddagger}, COLUMBIA, MISSOURI

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons


   Introduction
 
In the 1960s, effective techniques were developed for shunting hydrocephalus and for early closure of neural tube defects. As a result, orthopaedic surgeons were presented with the challenge of managing an emerging population of children who had myelomeningocele. Initially, the musculoskeletal problems in these children were treated with the modalities and expectations that had been learned from the treatment of poliomyelitis. However, it soon became apparent that the management of children who have myelomeningocele was not so simple. Additional factors include a decrease or loss of sensation affecting some or all parts of the lower extremities, associated congenital anomalies of the spine and lower extremities, and muscle imbalance that affects skeletal development over the entire period of growth. Furthermore, some patients who have myelomeningocele have a static encephalopathy that impairs coordination and results in the loss of strength of the lower and upper extremities29,30,45. Also, progressive neurological deterioration may . . . [Full Text of this Article]


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