Greater numbers of children with myelodysplasia will be encountered by Orthopaedic surgeons in the years to come86. The vast majority of these children have the potential for independent walking (Table XI). Successful treatment depends on knowledge of the level of neurological function preserved and its effect on the lower extremity. The earlier treatment is instituted, the more successful the end result. With knowledge of the level of the neurological lesion, it is possible to counsel the parents, providing them with a comprehensive outline of operative procedures and conservative measures needed to enable their child to walk. Surgical correction of the lower extremities in myelodysplasia carries with it very special hazards, including an increased risk of infection and of neurotrophic joint changes. In the presence of neurological function down through the third and fourth lumbar cord segments, paralytic dislocation of the hips is a frequent problem which can best be controlled by correcting all elements of the deformity and by providing a dynamic force to correct muscle imbalance. A modification of Mustard's iliopsoas transfer has been described.
Copyright 1964 by The Journal of Bone and Joint Surgery, Incorporated