When this position is maintained for even a few weeks, secondary soft tissue contractures occur; a permanent deformity develops The hip is externally rotated for comfort and, if not corrected, the external rotators of the hip contract and contribute to a fixed deformity When the deformity becomes extreme, the lateral tibial condyle subluxates on the lateral femoral condyle and the head of the fibula lies in the popliteal space.
An associated lumbar scoliosis can develop. If not corrected, the two contralateral contractures the band on the affected side and the trunk muscles on the unaffected side hold the pelvis in this oblique position until skeletal changes fix the deformity Total views 20, On Slideshare 0. From embeds 0. Number of embeds Downloads Shares 0.
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Now customize the name of a clipboard to store your clips. Visibility Others can see my Clipboard. Cancel Save. Exclusive 60 day trial to the world's largest digital library. The child will certainly have weakness and possibly paralysis as an adult, and therefore she should abstain from sports to prevent further muscle injury. Jason McKean. Poliomyelitis is a disease caused by viral destruction of the anterior horn cells in the spinal cord and brain stem motor nuclei.
Diagnosis is made clinically with presence of motor weakness with normal sensation in a patient with history of polio. Treatment may be nonoperative or operative depending on degree of functional limitation and presence of secondary contractures. Associated conditions. Postpolio syndrome.
Physical Exam. The rate has been reported between 3. Ironically, the management of a cVDPV outbreak is ensuring efficient vaccination in the area to stop the spread of the mutated neurovirulent viral strain. This started in April as a global coordinated effort to change from trivalent OPV containing types 1, 2 and 3 to bivalent OPV type 1 and 3. Several limitations of our study warrant consideration. Due to the rarity of the syndrome we were able to identify only a small number of cases.
We were unable to confirm a history of AFP in all but one child. This may be explained by a situation where the meningitic nature of a febrile illness was not appreciated. A mild neurological deficit, especially in young children, can easily be missed. As the subsequent clinical course is that of progressive recovery, healthcare opinion may not have been sought. Despite these shortcomings, the classic clinical findings of paralytic polio, supported by MRI findings in most cases, prompted us to compile this report.
We could not And any previous published reports of this clinical entity. Clinicians should remain familiar with sequelae of paralytic polio because, to quote the philosopher George Santayana, 'those who cannot remember the past are condemned to repeat it'.
While major strides have been made towards worldwide polio eradication, non-polio enteroviruses, VAPP and cVDPV may still cause a polio-like deformity. AFP surveillance should be strengthened to ensure all cases are identified early and deformities prevented or treated early. If the child presents years later, thorough clinical evaluation should exclude other causes of lower motor neuronopathy. MRI may be useful to identify features of previous neuroinvasive viral infection. Ethics statement.
The authors declare that this submission is in accordance with the principles laid down by the Responsible Research Publication Position Statements as developed at the 2nd World Conference on Research Integrity in Singapore, All procedures were in accordance with the ethical standards of the responsible committee on human experimentation institutional and national and with the Helsinki Declaration of , as revised in The authors declare authorship of this article and that they have followed sound scientific research practice.
This research is original and does not transgress plagiarism policies. Author contributions. KABS: Data capture, first draft preparation, manuscript revision. PHM: Manuscript revision and review. MG: Manuscript preparation and review.
LCM: Manuscript revision and review. DMT: Study design, data capture, manuscript review. Evaluating the acute flaccid paralysis surveillance system in South Africa, an analysis of secondary data. Pan Afr Med J. Joseph B, Watts H. Polio revisited: reviving knowledge and skills to meet the challenge of resurgence. J Child Orthop. Morgenstern J. Cognitive errors in medicine: The common errors. FirstlOEM blog, September 15, Inherited paediatric motor neuron disorders: beyond spinal muscular atrophy.
Neural Plast. No authors listed. South Africa certified polio-free. Acute flaccid myelitis: a clinical review of US cases Ann Neurol. Medical Research Council. Aids to the investigation of the peripheral nervous system. Because ligaments, the tissue which connects bones to bones, may be the weight-bearing substitute for paralyzed muscles, they can become stretched by long-term use. For example, when the quadriceps is paralyzed, the individual may lock the knee in an excessive hyperextensive position back knee.
With constant abuse, the individual muscle fibers yield to the strain, the deformity progresses, and pain follows. These symptoms can be relieved with a knee-ankle-foot orthosis KAFO designed to limit the back knee angle while allowing enough hyperextension to substitute for the absent quadriceps.
There is no effective surgical answer.
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