Physeo-epiphyseal injuries of lower extremities in myelomeningocele.

Abstract

During the last few years the neurosurgical and urological treatment of children with myelomeningocele has completely changed the prognosis of patients with this congenital defect. Consequently, at present myelomeningocele is the outstanding cause of paraplegia in childhood, and due to the better control of hydrocephalus and urinary tract infections the number of patients surviving the hazards of early infancy is increasing steadily. In Sheffield, 73 per cent of such infants were still alive after 2-3 years, and within the next decade, therefore, myelomeningocele will rival trauma as a cause of paraplegia in the young adult (Stark 1972). To the orthopedic surgeon this group of patients creates a series ot problems which, although not unique in every respect, demand reasoning and solutions in ways with which the orthodoxly educated orthopedic surgeon is not familiar. Examples of such problems are the paralytic hip dislocation and club foot in these patients, as well as the osteoporosis and liability to fractures which occur without any warning by pain. A “new” skeletal complication of patients with myelomeningocele has been encountered during the last two years, consisting in damage to the growth plate (physis) of the lower extremities, and, in one case, of the throclea tali. The lesion is characterized by a broadening and loosening of the physis, possibly due to repetitive trauma, and in one case proceeding to a virtual pseudarthrosis. This complication may prove to be of importance, since both growth rate and configuration of the affected bones are impaired.