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PURPOSE OF REVIEW: The purpose of this review is to update the role of the orthopedic surgeon in the management of Down syndrome as these patients are living longer and participating in sporting activities.
RECENT FINDINGS: Approximately 20% of all patients with Down syndrome experience orthopedic problems. Upper cervical spine instability has the most potential for morbidity and, consequently, requires close monitoring. Other conditions such as scoliosis, hip instability, patellar instability and foot problems can cause disability if left untreated. In some of these conditions, early diagnosis can prevent severe disability.
SUMMARY: Surgical intervention in children with Down syndrome has a high risk of complications, particularly infection and wound healing problems. Careful anesthetic airway management is needed because of the associated risk of cervical spine instability.
Joint stiffness and gait pattern evaluation in children with Down syndrome
Manuela Gallia, Chiara Rigoldi, Reinald Brunner, Naznin Virji-Babul and Albertini Giorgio Gait & Posture, Article in Press
Quote:
Hypotonia, ligament laxity and motor alterations are characteristic for patients with Down syndrome (DS). The purpose of this study was the evaluation of typical gait pattern of subjects with Down syndrome and the quantification of their joint stiffness, connected with ligament laxity and hypotonia, as a possible compensation.
98 children with DS (mean age: 11.7 years; range: 6–15 years) and 30 healthy children (control group (CG); mean age: 11 years; range: 5–13 years) underwent full 3D gait analysis at self-selected speed.
Subjects with DS walked with more hip flexion during the whole gait cycle, knee flexion in stance phase, a limitation of the knee range of motion, and plantarflexion of the ankle at initial contact. Ankle power was limited as evident in terminal stance and pre-swing, represented by a low propulsive capacity at push-off, too. Hip joint stiffness was increased in general in patients with DS versus normal subjects while ankle joint stiffness revealed a lower value instead.
The debate regarding surgical intervention in children with Down syndrome is interesting. It has been a source of debate for many years, with the major focus being on the systemic health of the child and the influence of general anaesthetic.
The presentation of such pathology in children with Down syndrome is greater that in children without Down syndrome. There are no such pathologies unique to this population. The decision regarding intervention must follow similar clinical pathways as with children without Down syndrome. The major additional factors however, relate to an understanding of the overall health of the child. This not only applies to surgical intervention but all forms of intervention.
Children with overall good systemic health will of course respond more favourably to treatment. This can extend from any health concerns particularly during infancy which may further decrease development. Of particular note is the impact of epilepsy on the development of children with Down sydrome.
An interesting debate indeed and helped along its way by articles such as the above.
Down syndrome
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