J Korean Orthop Assoc.  1975 Jun;10(2):191-199. 10.4055/jkoa.1975.10.2.191.

The Treatment of Fixed Pelvic Obliquity in Paralytic Scoliosis

• Lee SH
• Ahn JW
• Suk SI

• KMID: 2471393
• DOI: http://doi.org/10.4055/jkoa.1975.10.2.191

Abstract

The fixed pelvic obliquity, which constitutes a part of deformity present above and/or below the iliac crest, had remained out of interest until Dr. Mayer (1931) drew attention to its deteriorating role in body mechanics. But it was Dr. Irwin (1941. 1947) who developed the successful theory of pathogenesis of fixed pelvic obliquity. He believed that the most of the pelvic obliquities arise from contractures distal to the pelvis and few from unilateral weakness of lateral trunk muscles. He concluded that surgical release of the contractures below iliac crest by means of simple fasciotomy followed by cast correction or proximal femur osteotomy would be sufficient for their correction. But in cases that pelvic obliquity is ever present with paralytic scoliosis for considerable period and so fixed. problems met with will be much more intricate than usually expected. Our accumulated experiences of those cases has brought out the consideration that Irwin's idea is not uniformly fit for longstanding severe cases. The following conclusions were obtained by giving analysis on 4 cases of severe fixed pelvic obliquity associated with paralytic scoliosis who were treated in recent years in Department of Orthopedic Surgery, Seoul National University Hospital. 1. The thought that pelvic obliquities are mostly due to contractures below iliac crest was not always suitable. Which contracture above or below iliac crest is the primary one was uncertain in severely fixed cases. 2. It was not opposite but same side as that of abduction contracture of hip, of which lateral trunk muscle contractures prevent effective correction of fixed pelvic obliquity. This point was not mentioned by Dr. Irwin, or if ever by someone else forms a different idea from those ones previously reported. 3. It was convinced that the improvements or corrections of pelvic obliquities by soft tissue release alone are apt to recur in growing children. Continuous physical therapy and adequate application of Milwaukee brace was necessitated under careful observation in such cases. 4. If pelvic obliquity in paralytic scoliosis is longstanding and fixed, extensive spinal fusion using Harrington rod and sacral bar will finally be mandatory even in younger groups.

MeSH Terms

Braces
Child
Congenital Abnormalities
Contracture
Femur
Hip
Humans
Mechanics
Muscles
Orthopedics
Osteotomy
Pelvis
Scoliosis*
Seoul
Spinal Fusion