PMID: 9661867Jul 14, 1998Paper

Pathologic morphology of the dislocated proximal femur in children with cerebral palsy

Journal of Pediatric Orthopedics
D W LundyK J Guidera

Abstract

We describe the gross and microscopic anatomic changes in the hip that result from the deforming forces in children with neuromuscular imbalance. Twelve dislocated proximal femora that had been resected from children with spastic diplegia or tetraplegia were evaluated with respect to their gross, microscopic, and radiographic structure. The epiphyses were wedge shaped with deformation of the femoral head apparent in all cases. In addition to a severe loss of articular cartilage, a furrowed erosion of epiphyseal bone suggested a sustained, blunt, band-like force across the surface of the hip where it opposed the acetabular labrum. The underlying physis of the capital femur was irregular with aberrant histologic structure, whereas that of the lesser trochanter was hypertrophic and angulated in a superior and anterior direction. A significant degree of valgus was not noticeable in most specimens. In summary, the spastic adductor and iliopsoas, responsible for the changes in the lesser trochanter, work in conjunction with the hip flexor and internal rotator muscles to subluxate the proximal femur. In the process, the superior rim of the acetabulum and capsule causes focal deformation of the superolateral femoral head, creating a fu...Continue Reading

References

May 1, 1987·Journal of Pediatric Orthopedics·D R CoopermanE A Millar
Nov 1, 1985·Journal of Pediatric Orthopedics·R L SilverJ de la Garza

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Citations

Apr 28, 2006·The Orthopedic Clinics of North America·David A Spiegel, John M Flynn
Sep 18, 2009·Developmental Medicine and Child Neurology·Dennis R Carter, Brian Tse
Sep 12, 2006·Journal of Human Evolution·Timothy M Ryan, Gail E Krovitz
Oct 28, 2016·Journal of Children's Orthopaedics·Anthony L SilverioSamuel R Rosenfeld
Sep 25, 2017·American Journal of Physical Anthropology·Stephanie L Child, Libby W Cowgill
Jun 11, 2016·Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis·Philip Kam-Tao LiDavid W Johnson

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