POST POLIO RESIDUAL PARALYSIS with FLEXED KNEE

[CHERRY KOVOOR]

Dear Friends

 

Kindly advice if anything can be done for this case

30 yr old lady. c/o limping and cannot extend the knee [R] fully while walking

Walks without support

O/E- 45 deg knee flex contracture. Walks with flexed knee gait.

She has pelvic obliquity  and valgus of the distal femur 14 deg. and procurvatum 60 deg. There is no equinus

Her muscle power  quadriceps grade 0 and hip abductors grade IV on the [R] side. The other muscle groups are wither Grade V or IV in the [R[ side

Most likely she is a case of post polio residual paralysis.

What I would like to know  is can anything be done OR should anything be done?. Would a supracondylar osteotomy help to reduce her limp considering  that she has grade 0 quadricpes  power

There is no equinus deformity

Attaching clin pics in 2 mails

The gait video is on  http://www.youtube.com/watch?v=WhCUUythu4w   

Awaiting opinions

DR C CHERIYAN KOVOOR

KOCHI

INDIA

 

 

[CHERRY KOVOOR]

Another pics

[reverberi sandro]

Dear Kovoor,
your pictures show right rotula dislocated and femoro-tibial joint not
at all congruent (latero-lateral projection). Can you do a CT scan of
right knee with three-dimensional reconstruction?
Dr. Sandro Reverberi
Arcispedale S. Maria nuova
Reggio Emilia
Italy

2010/11/9 CHERRY KOVOOR <kovo...@gmail.com>:
> Another pics
>
> --
> You received this message because you are subscribed to the Orthopod Mailing
> List.
> To post to this group, send email to orth...@googlegroups.com
> To unsubscribe from this group, send email to
> orthopod-u...@googlegroups.com
> For more options, visit this group at
> http://groups.google.com/group/orthopod?hl=en
> ---
> Powered by Orthogate
> Improving orthopaedic care, education, and research using Internet
> technologies
> http://www.orthogate.org

[suresh bhola]

Respected Dr. Kavoor,

Kindly advice if anything can be done for this case. 

yes

30 yr old lady. c/o limping and cannot extend the knee [R] fully while walking

age 30 yrs. correction is difficult .

Walks without support

this is a good sign that she is using limb,without support.

O/E- 45 deg knee flex contracture. Walks with flexed knee gait.

45 deg. is too much to be corrected in one go with s/c ost.Has to have in 2 stages ,or some of soft tissues can be stretched by sk.traction through lower tibia,with ost.

She has pelvic obliquity  and valgus of the distal femur 14 deg. and procurvatum 60 deg. There is no equinus.

valgus can be taken care of by s/ c ost.

Her muscle power  quadriceps grade 0 and hip abductors grade IV on the [R] side. The other muscle groups are wither Grade V or IV in the [R[ side.

quad.0 grade is indication of correction by s/ c ost.

Most likely she is a case of post polio residual paralysis.

What I would like to know  is can anything be done OR should anything be done?. Would a supracondylar osteotomy help to reduce her limp considering  that she has grade 0 quadricpes  power

There is no equinus deformity

Attaching clin pics in 2 mails

The gait video is on  http://www.youtube.com/watch?v=WhCUUythu4w 

gait must include  the other sideview along front to back gait.

you must examine while she walks on bent knees,If hip is having flexion def. which is not compensated she will need hand on thigh.In that case you must correct hip flexion along with s/ c  ost. in the same sitting.

I will send you x rays of patient,whose movie i am sending to you.

http://www.youtube.com/watch?v=wCFWUijW-Gc 

with regards

--
Dr. Suresh Kumar Bhola
Bhola Orthopedics and Dental Hospital,
Railway Road, Kurukshetra
pin-136118
Ph.-01744-290841

[suresh bhola]

You have been sent 5 pictures.

DSC09833.JPG
DSC00003.JPG
DSC00004.JPG
DSC08605.JPG
DSC01009.JPG

These pictures were sent with Picasa, from Google.
Try it out here: http://picasa.google.com/

[Dr.Vishwanath Iyer]

Dr Cherian,

This is definitely postpolio residual paralysis. (The wasting is glaring) The flexion deformity has caused apparant shortening and so she has this pelvic obliquity. Kindly examine the pelvis. The pelvis should be correctable passively; she must not be having any abduction deformity and finally look for Fixed flexion deformity of the hip too. The same shortening has made the knee go into valgus and in due course bony changes have taken place.

If she has correctable pevic obliquity, no FFD of hip, she can definitely be helped.

The knee deformity looks much less than 45* as mentioned by you. She is able to walk with a flexed knee and without hand on the knee means her hamstrings must be very strong. You have mentioned procurvatum of the distal femur. I am not able to appreciate it in the Xrays attached

A supra condylar  recurvatum (and varus) osteotomy of the femur will definitely improve her gait.

Cheers!!

V M Iyer

--

You received this message because you are subscribed to the Orthopod Mailing List.
To post to this group, send email to orth...@googlegroups.com
To unsubscribe from this group, send email to orthopod-u...@googlegroups.com
For more options, visit this group at http://groups.google.com/group/orthopod?hl=en
---
Powered by Orthogate
Improving orthopaedic care, education, and research using Internet technologies
http://www.orthogate.org

--
Dr Vishwanath M Iyer
B106, Kumaradhara, N G V, Bangalore. 560047
91 80 25712134 919742399481

103, Railway lines,Solapur.413001
91 217 2317597/2316783