Selective affection of AHC in an un-immunized child causes asymmetrical motor paralysis with intact sensation.
It produces
- Deformity: deformity is due to gravity, muscle imbalance and posture
- Weakness
- LLD
- Instability
Aim
- Correct deformity
- Grant muscle balance
- Restore stability
- Equalize limbs
Non-Surgical Management
Orthotics
Deformities
Hip
- FABER Hip
- Release TFL, Sartorius, and Deep Fascia
Knee
- Flexion and ER (External Rotation)
- Posterior Subluxation
- 'Yount's Procedure'
- Transection and excision of part of ITB
- Hamstring Transfer
Cavus Foot
Steindler Procedure- Tpost, Medial Calcaneal Vessels & Nerve are at risk
Equinus Deformity
Z Plasty Elongation of Achilles Tendon
Equino cavus
JESS Fixator
Muscle Imbalance
Gluteal Paralysis
Leads to Strong Iliopsoas and Dislocation
Musculo-Aponeurotic Transfer of External Oblique Muscle
Psoas Transfer- can cause injury to femoral nerve, AVN hip and weak flexion
Knee
Quadriceps Weakness
Hamstring Transfer
MRC ≥ 4
No Knee Contracture
Hip Flexion ≥ 3 (Biceps & ST Transfer)
Supracondylar Extension Osteotomy
- Hamstring ≤ 3
- Flexion Contracture < 20°
- Bring Weight-Bearing Axis Anterior to Knee
Foot & Ankle
- EDL Transfer
- Tibialis Anterior Transfer
- Triple Arthrodesis