University Childrens Hospital Basle

Basel, Switzerland

University Childrens Hospital Basle

Basel, Switzerland
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Behrendt F.,University Childrens Hospital Basle | De Lussanet M.H.E.,University of Munster | Zentgraf K.,University of Munster | Zschorlich V.R.,University of Rostock
PLoS ONE | Year: 2016

Facilitation of the primary motor cortex (M1) during the mere observation of an action is highly congruent with the observed action itself. This congruency comprises several features of the executed action such as somatotopy and temporal coding. Studies using reachgrasp- lift paradigms showed that the muscle-specific facilitation of the observer's motor system reflects the degree of grip force exerted in an observed hand action. The weight judgment of a lifted object during action observation is an easy task which is the case for hand actions as well as for lifting boxes from the ground. Here we investigated whether the cortical representation in M1 for lumbar back muscles is modulated due to the observation of a whole-body lifting movement as it was shown for hand action. We used transcranial magnetic stimulation (TMS) to measure the corticospinal excitability of the m. erector spinae (ES) while subjects visually observed the recorded sequences of a person lifting boxes of different weights from the floor. Consistent with the results regarding hand action the present study reveals a differential modulation of corticospinal excitability despite the relatively small M1 representation of the back also for lifting actions that mainly involve the lower back musculature. © 2016 Behrendt et al. This is an open ccess article distributed under the terms of the reative Commons Attribution License, which permits nrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Sesia S.B.,University Childrens Hospital Basle | Haecker F.-M.,University Childrens Hospital Basle | Kubiak R.,University of Zürich | Mayr J.,University Childrens Hospital Basle
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2010

Aim: In childhood, laparoscopy-assisted single-port appendectomy (SPA), including the advantages of open and laparoscopic surgery, is not widely used. However, there is debate whether the retrieval of the infected appendix via the umbilicus results in a higher infection rate compared with other laparoscopic or open techniques. The aim of the study was to determine the postoperative infection rate and possible risk factors for infection after SPA in children. Methods: For this retrospective study, case notes of all children (n = 262) who underwent SPA between August 2005 and December 2008 were reviewed. Those children in whom the preoperative ultrasonography revealed suspected perforation were excluded from SPA and subsequently underwent open surgery. SPA was performed using a 12-mm trocar with one 5-mm working channel, introduced through a sub-umbilical incision. After grasping the appendix with atraumatic forceps, the appendix was exteriorized through the umbilicus and dissected outside the abdominal cavity as in open surgery. Preoperatively, each patient received one dose of Metronidazole and Cefuroxime, and the umbilicus was cleaned in particular. Results: Of the 262 children who underwent SPA, 146 were boys (55.7%) and 116 girls (44.3%). Median age at operation was 11.4 years (range, 1.1-15.9). Six obese (with a body mass index greater than the 95th percentile) children (2.3%) developed intra-abdominal abscess after perforated appendicitis that was treated with a course of antibiotics. One child required revisional surgery and drainage. The median length of antibiotic treatment was 3 days (range, 0-15). Conclusion: In our institution, SPA is the method of choice for appendectomy in children with acute appendicitis, in whom preoperative ultrasound does not reveal signs of perforation. The infection rate (2.7%) after SPA is not increased compared with other laparoscopic or open techniques. Overweight (body mass index greater than the 95th percentile) and perforated appendicitis seem to increase the risk of postoperative infectious complications. © 2010, Mary Ann Liebert, Inc.


Rutz E.,University Childrens Hospital Basle | Rutz E.,Murdoch Childrens Research Institute | Gaston M.S.,University Childrens Hospital Basle | Camathias C.,University Childrens Hospital Basle | Brunner R.,University Childrens Hospital Basle
Journal of Pediatric Orthopaedics | Year: 2012

BACKGROUND: In patients with cerebral palsy and other neuromuscular disorders, correction of a fixed knee flexion deformity is thought to be crucial for the improvement of gait. The distal femoral extension osteotomy (DFO) is one method to achieve this goal. The standard implant for fixation of the 2 fragments in DFO is the conventional AO blade plate. The aim of this study was to report the outcome of using the new LCP Pediatric Condylar 90-Degree Plate for DFO. METHODS: Thirty-eight patients undergoing 63 DFOs were included. The mean age was 16.3±4.4 years (range, 4 to 27 y) at the time of surgery. Thirty-two patients had a diagnosis of cerebral palsy and 6 patients had other neuromuscular disorders including myelomeningocoele and arthrogryposis. Thirteen patients had unilateral procedures and 25 had bilateral procedures. RESULTS: The mean duration of the surgical intervention was 67.9±26.5 minutes (range, 30 to 180 min) and the mean blood loss was 100.0±42.1 mL (range, 50 to 250 mL). In 84% of the cases, large-fragment (5.0 mm) implants were used. The mean extension correction in 84% of the patients (n=53) was 22.8±10.3 degrees (range, 5 to 50 degrees). In this series, there were 2 complications in 63 osteotomies (3%). Radiologic follow-up of the cohort was until the time of plate removal (14.2±4.3 mo; range, 6 to 26 mo). Three months after the index operation, all osteotomies were radiologically consolidated. At this time and at plate removal, there were no malunions or nonunions in this cohort. Clinical follow-up of the cohort was performed until the end of the study (mean 35.5±6.7 mo; range, 22 to 46 mo). At the end of the study, 59 plates (94%) had been removed. CONCLUSIONS: The new LCP Pediatric Condylar 90-Degree Plate provides stable and safe fixation of distal femoral correction osteotomies in patients with neuromuscular disorders. LEVEL OF EVIDENCE: Level IV. Copyright © 2012 by Lippincott Williams & Wilkins.


Rutz E.,Murdoch Childrens Research Institute | Rutz E.,University Childrens Hospital Basle | Donath S.,Murdoch Childrens Research Institute | Donath S.,University of Melbourne | And 7 more authors.
Gait and Posture | Year: 2013

Purpose: This is a study of all children with spastic diplegic cerebral palsy (Gross Motor Classification System levels II and III) who had single event multi-level surgery (SEMLS) at a single tertiary referral hospital between 1995 and 2008 to identify factors predicting improvement in gait quality as quantified by the gait profile score (GPS). 9 factors (5 dichotomous and 4 continuous, including preoperative GPS) that might be expected to predict outcomes were identified and univariate and multivariable analysis used to explore how these affected outcomes. Scope: Data from 121 children were included. The mean improvement in GPS of 4.3° was 2.7 times the minimal clinically important difference. Univariate analysis suggested that preoperative GPS is a very strong predictor of improvement in GPS (p<10-5) and when this is considered as a covariate only GMFCS level (p=10-5) and having had previous surgery (p=0.026) were found to be statistically significant predictors of GPS improvement (p<0.05). Children of GMFCS level II improved on average by 2° more than those of level III once differences in preoperative GPS had been accounted for. Conclusion: Children with the most abnormal gait patterns preoperatively, and hence those with the most potential to improve are those that improve the most and surgery has clearly been beneficial. Over a quarter of children show changes in GPS which were less than the MCID. The majority of these were those with the least abnormal gait patterns preoperatively and further research is required to establish whether and how such children benefit from SEMLS. © 2013 Elsevier B.V.


Rutz E.,University Childrens Hospital Basle | Hofmann E.,University Childrens Hospital Basle | Brunner R.,University Childrens Hospital Basle
Journal of Orthopaedic Science | Year: 2010

Background: Muscle weakening is a well-known side effect of muscle-tendon lengthening. Botulinum toxin A (BTX-A) weakens the muscle temporarily by blocking the neuromuscular junction. Hence application of the drug is a logical step to test whether weakness deteriorates function prior to an operation. In the present study, BTX-A application is used to test preoperatively whether the gait pattern depends on the strength of the tested muscle. Since 1999, instrumented gait analysis, including kinematic, kinetic, and dynamic electromyographic data, is routinely used to define the individual surgical program. Methods: In our series of 110 consecutive patients with cerebral palsy (CP) considered for surgical muscle lengthening from 1999 to 2008, BTX-A was applied to identify patients at risk for functional deterioration. Gait analysis was repeated 6 weeks (maximum effect of BTX-A) and 12 weeks (follow-up) after the test injection to check for loss of joint control (excessive ankle dorsiflexion, knee flexion, increased anterior pelvic tilt). Results: In all, 20.9% (n = 23) showed deterioration in gait after preoperative BTX-A test injections (n = 112, two patients had two test trials) in all muscles considered for lengthening. As a consequence, their lengthening surgery was canceled. A total of 68 patients underwent surgery as planned, and in none of them did gait function deteriorate. These clinical data were compared to those of a historical group (n = 105) before this test, where 18% showed functional deterioration after surgery. The similar percentage of patients filtered out by the test suggests that there could be a context to the number of poor results in the historical group. Conclusions: We conclude that preoperative BTX-A test injection is a reliable tool for filtering out patients with risk of deterioration after muscle lengthening surgery in patients with CP and can be helpful to avoid poor outcomes. © 2010 The Japanese Orthopaedic Association.


McGinley J.L.,Murdoch Childrens Research Institute | McGinley J.L.,University of Melbourne | Dobson F.,University of Melbourne | Ganeshalingam R.,The Royal Childrens Hospital | And 6 more authors.
Developmental Medicine and Child Neurology | Year: 2012

Aim To conduct a systematic review of single-event multilevel surgery (SEMLS) for children with cerebral palsy, with the aim of evaluating the quality of the evidence and developing recommendations for future research. Method The systematic review was conducted using standard search and extraction methods in Medline, EMBASE, CINAHL, and Cochrane electronic databases. For the purposes of this review, SEMLS was defined as two or more soft-tissue or bony surgical procedures at two or more anatomical levels during one operative procedure, requiring only one hospital admission and one period of rehabilitation. Studies were included if: (1) the primary focus was to examine the effect of SEMLS in children with cerebral palsy; (2) the results focused on multiple anatomic levels and reported findings of one or more World Health Organization International Classification of Functioning, Disability and Health (ICF) domains. Studies that focused on a single intervention or level, or on the utility of a specific outcome measure were excluded. Study quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. The review also examined the reporting of surgery, adverse events, and rehabilitation. Results Thirty-one studies fulfilled the criteria for inclusion, over the period 1985 to October 2010. The MINORS score for these studies varied from 4 to 19, with marked variation in the quality of reporting. Study quality has improved over recent years. Valid measures of gait and function have been introduced and several of the most recent studies have addressed multiple dimensions of the ICF. A statistical synthesis of the outcome data was not conducted, although a trend towards favourable outcomes in gait was evident. Caution is advised with interpretation owing to the variable study quality. Uncontrolled studies may have resulted in an overestimation of treatment efficacy. Interpretation The design and reporting of studies of SEMLS are improving with the development of multidisciplinary teamwork and frameworks such as the ICF. However, the evidence base is limited by the lack of randomized clinical trials, especially when compared with other surgical interventions such as selective dorsal rhizotomy. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.


Rutz E.,University Childrens Hospital Basle | Rutz E.,Royal Childrens Hospital | Rutz E.,Murdoch Childrens Research Institute | Passmore E.,Royal Childrens Hospital | And 5 more authors.
Clinical Orthopaedics and Related Research | Year: 2012

Background: Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development. Questions/purposes: We asked whether varus derotational osteotomy of the proximal femur, combined with adductor release, influenced hip development in patients with Type IV hemiplegia having multilevel surgery. Patients and Methods: We retrospectively reviewed 11 children and adolescents with Type IV hemiplegia who had a proximal femoral osteotomy due to unilateral hip displacement to correct gait dysfunction between 1999 and 2006. The mean age at the time of surgery was 11.1 years (range, 7 to 16 years). We obtained the Movement Analysis Profile and Gait Profile Score before and after surgery. We also measured the Migration Percentage of Reimers and applied the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The minimum followup was 2 years 3 months (mean, 6 years 6 months; range, 2 years 3 months to 10 years 8 months). Results: The majority of gait parameters improved but hip development was not normalized. According to the MCPHCS at last followup, no hips were classified as Grade I, two hips were classified as Grade II, and the remainder were Grade III and IV. Conclusions: Unilateral surgery including a proximal femoral osteotomy improved gait and walking ability in individuals with spastic hemiplegic cerebral palsy. However, hip dysplasia persists. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons®.


Rutz E.,Murdoch Childrens Research Institute | Rutz E.,University Childrens Hospital Basle | Baker R.,Murdoch Childrens Research Institute | Tirosh O.,Murdoch Childrens Research Institute | Brunner R.,University Childrens Hospital Basle
Clinical Orthopaedics and Related Research | Year: 2013

Background: Gait and function may deteriorate with time in patients with spastic diplegia. Single-event multilevel surgery often is performed to either improve gait or prevent deterioration. However it is unclear whether the presumed gait improvements are durable. Questions/purposes: We therefore determined whether (1) single-event multilevel surgery improves gait in patients with spastic diplegia and (2) whether the improved function is durable. Methods: We retrospectively reviewed the data of 14 patients with spastic diplegia. At the time of surgery, one patient had gross motor Level I function, 10 patients had Level II function, and three patients had Level III function. There were four females and 10 males with a mean age of 13 years (range, 7-18 years). The mean number of orthopaedic procedures per single-event multilevel surgery session was 7.4 ± 2.8 (median, 6.5; range, 4-15). We used instrumented gait analysis to determine joint ROM, movement analysis profiles, and the gait profile score. The minimum followup was 1 year (mean, 2 years; range, 1-3 years). Results: At last followup, movement analysis profiles for knee flexion, for ankle dorsiflexion, and for foot progression improved as did the gait profile score. Additional surgery after the index procedure was performed in nine of the 14 patients because of relapse of the original or new gait problems. Major surgical adverse events occurred in one of the 14 patients. Conclusions: Severe gait dysfunction in patients with spastic diplegia can be improved short-term in one operative session by single-event multilevel surgery, but to preserve the early improvements many patients require additional surgery. It is unknown whether the improvements will last for decades. Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2012 The Association of Bone and Joint Surgeons®.


Rutz E.,University Childrens Hospital Basle | Rutz E.,Murdoch Childrens Research Institute | Baker R.,Murdoch Childrens Research Institute | Tirosh O.,Murdoch Childrens Research Institute | And 3 more authors.
Gait and Posture | Year: 2011

Equinus is the commonest deformity in cerebral palsy (CP). Many different surgical procedures have been described for the treatment of spastic equinus. In long standing equinus deformities the tibialis anterior muscle becomes elongated which is one reason for muscle weakness. Surgical tendon shortening of the tibialis anterior tendon was therefore introduced to rebalance muscle strength.All patients with CP who had a tibialis anterior tendon shortening (TATS) in combination with a tendo Achilles lengthening (TAL) were included in this study. A total of 29 patients had 30 surgical interventions (21 hemiplegic patients: 14 boys/7 girls, age 9-22 years; mean 15.2 years; 5 diplegics and 3 quadriplegics; 5 boys/3 girls, age 7-37.5 years; mean 14.8 years). Fifteen patients had additional surgery (soft tissue or bony procedures). The TATS was performed at the distal insertion with transosseous tendon fixation in the medial cuneiform bone at the original place.Movement Analysis Profile (MAP) for ankle dorsi-/plantarflexion, Gait Profile Score (GPS), Gait Deviation Index (GDI), and Gillette Gait Index (GGI) improved significantly for all patients compared pre- to postoperatively. In 93% of the patients active dorsiflexion of the ankle was possible postoperatively.We conclude that TATS in combination with TAL in spastic equinus in CP is a safe procedure and improves but not completely corrects foot positioning during gait. For the treatment of spastic equinus in CP we recommend shortening of the elongated antagonist (TATS) in combination with lengthening of the short agonist (TAL) for achieving optimal postoperative function. © 2010 Elsevier B.V.


Rutz E.,University Childrens Hospital Basle | Rutz E.,Murdoch Childrens Research Institute | Gaston M.S.,University Childrens Hospital Basle | Tirosh O.,Murdoch Childrens Research Institute | Brunner R.,University Childrens Hospital Basle
HIP International | Year: 2012

Background: It is unclear if psoas lengthening surgery is required in the treatment of patients with cerebral palsy (CP) with hip flexion deformity and previous studies show equivocal results with regard to functional outcome. Methods: This study retrospectively assessed 12 patients with a diagnosis of spastic diplegia who underwent single event multilevel surgery in order to correct deformities in the sagittal plane distal to the hip. Both clinical and instrument gait analysis results were recorded preoperatively, at one year (short term) and at five years (mid term) postoperatively. Results: Clinically measured hip and knee movement improved at both short and mid term follow up. Correlations of clinically measured maximum hip and knee extension were significant at all three time points. Angles at terminal stance/toe off for hip and knee from kinematic data also showed significant correlations at all three time points. Conclusions: Our study demonstrates that the hip flexion deformities encountered in these patients will improve spontaneously when the distal fixed knee flexion deformity is surgically corrected. Therefore correction at the knee allows the ground reaction force to assume a more normal position resulting in correction at the hip over time. This then removes the need for surgery at the hip level. This fact is especially important when applied to psoas lengthening as this procedure can cause significant reduction in propulsion power. © 2012 Wichtig Editore.

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