Equinus deformity and haemangioma of calf muscle

Images

Smallpox vaccination during pregnancy

The obstetric outcome (abortions, stillbirths, prematurity, mature births, and congenital abnormalities) in a group of 1522 consecutive pregnant patients who had smallpox vaccinations during recent pregnancies was compared to that in a similar control group of 2024 consecutive pregnant patients who did not receive any antenatal vaccination. Results showed that smallpox vaccination during pregnancy did not increase the rate of stillbirths, premature births, or congenital abnormalities in patients who had been vaccinated at least once before. However, it was noted that women vaccinated during the first trimester of pregnancy more often had children with clubfoot. Therefore, unless there is an immediate risk, we recommend delaying smallpox vaccination during pregnancy until the second or third trimester. However, during epidemic, vaccination should be done regardless of gestational age.

Talectomy in the treatment of the myelomeningocele patient

This paper is an analysis of a series of 11 pediatric myelomeningocele patients in whom 20 talectomies were performed for correction of rigid equinovarus of paralytic vertical talus deformities. In most of the patients talectomy achieved a satisfactory correction of the foot deformity with maintenance of the correction for up to 5 years of follow-up in this study. Failure of the procedure related to two factors: (1) severe external rotational contracture of the hips in patients with high spinal lesions; (2) incomplete removal of the talus because of extensive scarring and fibrosis due to prior infection or surgery. Correction of the external rotational deformity of the hip or a derotational supramalleolar osteotomy of the tibia can prevent the first cause of failure. An intra-operative X-ray of the foot can prevent the latter.

Congenital myotonic dystrophy in Britain. I. Clinical aspects

A clinical and genetic study of congenital myotonic dystrophy in Britain has been carried out in 70 patients from 54 sibships. The clinical aspects are analysed here, and the existence of a syndrome clinically distinct from myotonic dystrophy of later onset is confirmed. Characteristic features included neonatal hypotonia, motor and mental retardation, and facial diplegia. A high incidence of talipes occurs at birth together with hydramnios and reduced fetal movements during pregnancy, factors suggesting prenatal onset of the disorder in many cases. Prolonged survival is the rule after infancy, but the occurrence of numerous neonatal deaths in the sibships suggests the existence of unrecognized cases dying in the neonatal period.

Correction of equinus in cerebral palsy by the Murphy procedure of tendo calcaneus advancement: a preliminary communication

The biomechanics of the Murphy procedure for correction of equinus in cerebral palsy are presented. A series of 79 surgical procedures on 48 patients, with a follow-up period of from one to four years, is reviewed. Correction of equinus was succeswful in 89-9 per cent of the procedures. Using the Murphy procedure the following advantages over other methods of correction are anticipated: (1) no loss on 'push-off' in gait; (2) no loss of correction (recurrence) during longitudinal growth of the child, necessitating repeated surgery; and (3) no need for continual night bracing during the growth period.

Congenital postural deformities: perinatal associations

Images

The syndrome of arthrogryposis multiplex congenita

Arthrogryposis Multiplex Congenita (AMC) is a syndrome characterized by confenital rigidity or "clubbing" of multiple joints. Soft-tissue ankylosis restricts the motion of the joints, which are fixed in postures dictated by the position of the embryo during development. The joint malformations result from relatively brief immobilization of the developing embryo due to a variety of factors. This concept of pathogenesis derives support from the experimental reproduction of AMC in chick embryos paralyzed by a variety of pharmacologic agents. In man, prenatal disorders which are capable of immolilizing the embryo give rise to AMC. These disorders may affect the brain, spinal cord, peripheral nerves, or muscles. Various mechanical factors that restrict the embryo's movements can also produce joint malformations. Thus, AMC should be regarded as a syndrome of articular malformations which may stem from many different causes rather than as a disease entity.