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A COMPARATIVE STUDY OF THE RELATIVE VALUE OF VARIOUS SURGICAL PROCEDURES IN THE TREATMENT OF INFANTILE PARALYSIS OF THE LOWER EXTREMITY.

THOMSON, JAMES E. M.
The Journal of Bone & Joint Surgery: July 1924
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The purpose of an orthopaedic operation is: first, to correct deformity; second, to improve function; third, to give additional comfort to the patient; and fourth, to stabilize the foot sufficiently to make braces and splints unnecessary, or make it possible for the patient to wear apparatus previously unwearable on account of the deformity.

The average grades received by each operation performed in the treatment of infantile paralysis of the lower extremity in our series, and the extent to which each has fulfilled the above requirements, have been estimated, and from these grades the deductions made as follows-

1. Since most of these operations were performed before the war sufficient time has elapsed to estimate the ultimate result.

2. Operations of the paralytic lower extremity should return the part to at least within 20 per cent. of normal; that is, achieve a general average of 80 per cent.

20 per cent. Correction of deformity.

20 per cent. Improvement of function.

20 per cent. Additional comfort to the patient.

20 per cent. for apparatus lessened or made more wearable.

3. That arthrodesis of the ankle and astragalectomy uniformly meet the above requirements in every particular, and are by far the most stabilizing measures we have used for paralytic foot deformities.

4. Tendon transplantations, tendon fixations, and silk ligaments about the foot, as a class, do not meet the requirements outlined to a sufficient degree to warrant them as dependable operations. However, there were spectacular results in certain instances.

5. Lengthening of the tendo Achillis, plantar fasciotomy, and the various combinations of fasciotomies and tenotomies uniformly gave good results for the correction of minor paralytic deformities, although their success is largely dependable upon the long period of fixation and over-correction. Forcible correction is usually inadequate, as many relapses occurred in this series.

6. Of the operations about the knee, transplantation of hamstrings to quadriceps and patella uniformly gave good results, and are therefore considered relatively dependable. Lengthening of the hamstrings mainly corrects deformity without increasing stability or function. Supracondylar osteotomy, by the production of a back knee, is a splendid stabilizing measure. Arthrodesis of the knee for stabilization of flail knee, if the patient has good gluteal muscles, is a splendid procedure, and should more often be considered in extensive paralytic involvement of the extremity, especially after the ankle has been stabilized.

7. Thigh operations such as fascia, muscular sectioning, and Soutter operations, for the correction of flexion deformities are of great help in making severely deformed individuals more comfortable, and in giving them an opportunity to wear practical braces.

(C) 1924 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.

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