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Article ; Online: Growth dynamics in the context of pediatric sports injuries and overuse.

Zwick, Ernst B / Kocher, Robert

2014 Volume 18, Issue 5, Page(s) 465–468

Abstract: The onset and timing of the growth of children and adolescents occurs with considerable variability in cohorts of the same chronological age. The musculoskeletal system changes in proportion over time, and lever-arm changes, altered individual ... ...

Abstract	The onset and timing of the growth of children and adolescents occurs with considerable variability in cohorts of the same chronological age. The musculoskeletal system changes in proportion over time, and lever-arm changes, altered individual flexibility, and strength lead to age-specific injury patterns in youth sports. In sports, juniors are commonly grouped according to their chronological age. Early- and late-maturing children and adolescents might therefore not routinely be trained in relation to their biology. This not only represents a risk for overuse and injury but might limit their development in sports. To obtain information about the biological age of children is challenging. Numerous methods have been studied and validated. However, the implementation of these methods on a large scale is still to come. This report provides a brief overview of growth dynamics in relation to youth sports injuries and describes a few challenges for the future.
MeSH term(s)	Adolescent ; Athletic Injuries/physiopathology ; Athletic Injuries/prevention & control ; Bone Density/physiology ; Cartilage/physiology ; Child ; Child Development ; Cumulative Trauma Disorders/physiopathology ; Cumulative Trauma Disorders/prevention & control ; Humans ; Physical Education and Training ; Risk Factors
Language	English
Publishing date	2014-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0034-1389263
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Article: Growth Dynamics in the Context of Pediatric Sports Injuries and Overuse

Zwick, Ernst B. / Kocher, Robert

Seminars in Musculoskeletal Radiology

(Sports Injuries and Imaging in Children)

2014 Volume 18, Issue 05, Page(s) 465–468

Series title	Sports Injuries and Imaging in Children
Abstract	The onset and timing of the growth of children and adolescents occurs with considerable variability in cohorts of the same chronological age. The musculoskeletal system changes in proportion over time, and lever-arm changes, altered individual flexibility, and strength lead to age-specific injury patterns in youth sports. In sports, juniors are commonly grouped according to their chronological age. Early- and late-maturing children and adolescents might therefore not routinely be trained in relation to their biology. This not only represents a risk for overuse and injury but might limit their development in sports. To obtain information about the biological age of children is challenging. Numerous methods have been studied and validated. However, the implementation of these methods on a large scale is still to come. This report provides a brief overview of growth dynamics in relation to youth sports injuries and describes a few challenges for the future.
Keywords	youth sports ; growth velocity ; injury
Language	English
Publishing date	2014-10-28
Publisher	Thieme Medical Publishers
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0034-1389263
Database	Thieme publisher's database

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Article ; Online: Lengthening of the midfoot in a case of lower-extremity hemimelia.

Kraus, Tanja / Zwick, Ernst B / Svehlik, Martin / Linhart, Wolfgang E

Journal of the American Podiatric Medical Association

2011 Volume 101, Issue 5, Page(s) 456–461

Abstract: Hemimelia of the lower limb belongs to the group of congenital deficiency disorders. The clinical spectrum ranges from minimal shortening of the long bones to severe deficiencies of the extremities. Several etiologies, such as X-rays or drugs, have been ... ...

Abstract	Hemimelia of the lower limb belongs to the group of congenital deficiency disorders. The clinical spectrum ranges from minimal shortening of the long bones to severe deficiencies of the extremities. Several etiologies, such as X-rays or drugs, have been implicated to be responsible for hemimelia. In the present report the clinical course and the long-term follow-up of a patient with transverse terminal hemimelia of the left foot at the level of the basis of the metatarsals is described. Due to frequent episodes of pain, development of pressure sores, and an increasing psychological burden, operative intervention consisting of a lengthening procedure using an Ilizarov fixator was indicated. Long-term outcome was good; the patient is now able to painlessly wear conventional shoes and displays a normal gait pattern.
MeSH term(s)	Adult ; Ectromelia/diagnostic imaging ; Ectromelia/surgery ; External Fixators ; Foot/surgery ; Foot Deformities, Congenital/diagnostic imaging ; Foot Deformities, Congenital/surgery ; Forefoot, Human/surgery ; Humans ; Ilizarov Technique ; Male ; Osteotomy ; Radiography ; Shoes
Language	English
Publishing date	2011-09-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	632622-5
ISSN	1930-8264 ; 0003-0538 ; 8750-7315
ISSN (online)	1930-8264
ISSN	0003-0538 ; 8750-7315
DOI	10.7547/1010456
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Article ; Online: Does gender influence the long-term outcome of single-event multilevel surgery in spastic cerebral palsy?

Zwick, Ernst B / Svehlík, Martin / Kraus, Tanja / Steinwender, Gerhard / Linhart, Wolfgang E

Journal of pediatric orthopedics. Part B

2012 Volume 21, Issue 5, Page(s) 448–451

Abstract: This study compared the long-term outcome of single-event multilevel surgery in spastic diplegic cerebral palsy (CP) on the basis of sex. We hypothesized that boys would have a worse outcome than girls. Thirty-four children (19 boys and 15 girls) with ... ...

Abstract	This study compared the long-term outcome of single-event multilevel surgery in spastic diplegic cerebral palsy (CP) on the basis of sex. We hypothesized that boys would have a worse outcome than girls. Thirty-four children (19 boys and 15 girls) with diplegic spastic CP and a minimal follow-up of 10 years were included. The Gillette Gait Index was the main outcome measure. We found no differences in surgical treatment, and both groups initially benefited from the surgery. However, although girls maintained the enhanced level of walking, walking ability in boys deteriorated constantly. Such a finding suggests that sex might have an important influence on treatment outcomes in children with CP.
MeSH term(s)	Cerebral Palsy/complications ; Cerebral Palsy/physiopathology ; Cerebral Palsy/surgery ; Child ; Diagnosis, Computer-Assisted/methods ; Disability Evaluation ; Female ; Gait Disorders, Neurologic/etiology ; Gait Disorders, Neurologic/physiopathology ; Gait Disorders, Neurologic/surgery ; Health Status Indicators ; Humans ; Male ; Orthopedic Procedures/adverse effects ; Orthopedic Procedures/methods ; Outcome Assessment (Health Care) ; Postoperative Complications ; Severity of Illness Index ; Sex Factors ; Treatment Outcome ; Walking/physiology
Language	English
Publishing date	2012-09
Publishing country	United States
Document type	Comparative Study ; Journal Article
ISSN	1473-5865
ISSN (online)	1473-5865
DOI	10.1097/BPB.0b013e32834d4daa
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Article ; Online: Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.

Svehlík, Martin / Kraus, Tanja / Steinwender, Gerhard / Zwick, Ernst B / Linhart, Wolfgang E

International orthopaedics

2011 Volume 36, Issue 6, Page(s) 1235–1241

Abstract: Purpose: Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait ...

Abstract	Purpose: Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip. Methods: Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall. Results: Children in the "unloading" group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The "normal-loading" group showed pelvis elevation with a neutral hip position in the frontal plane. In the "overloading" group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them. Conclusion: The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.
MeSH term(s)	Child ; Exercise Therapy ; Female ; Gait/physiology ; Gait Disorders, Neurologic/etiology ; Gait Disorders, Neurologic/physiopathology ; Gait Disorders, Neurologic/therapy ; Hip Joint/pathology ; Hip Joint/physiopathology ; Humans ; Knee Joint/pathology ; Knee Joint/physiopathology ; Legg-Calve-Perthes Disease/complications ; Legg-Calve-Perthes Disease/physiopathology ; Legg-Calve-Perthes Disease/therapy ; Male ; Range of Motion, Articular ; Recovery of Function ; Weight-Bearing
Language	English
Publishing date	2011-12-02
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80384-4
ISSN	1432-5195 ; 0341-2695
ISSN (online)	1432-5195
ISSN	0341-2695
DOI	10.1007/s00264-011-1416-2
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Article ; Online: Genu recurvatum in cerebral palsy--part B: hamstrings are abnormally long in children with cerebral palsy showing knee recurvatum.

Zwick, Ernst B / Svehlík, Martin / Steinwender, Gerhard / Saraph, Vinay / Linhart, Wolfgang E

Journal of pediatric orthopedics. Part B

2010 Volume 19, Issue 4, Page(s) 373–378

Abstract: Hyperextension of the knee in stance (knee recurvatum) is a common disorder in patients with spastic cerebral palsy (CP). A group 35 children with CP (47 lower limbs) was divided into two subgroups according to the timing of maximum knee extension during ...

Abstract	Hyperextension of the knee in stance (knee recurvatum) is a common disorder in patients with spastic cerebral palsy (CP). A group 35 children with CP (47 lower limbs) was divided into two subgroups according to the timing of maximum knee extension during the stance phase of gait. Gait analysis and musculoskeletal modelling data were compared with a control group of 12 normally developing children. We observed no difference in kinematics between the CP groups who showed an equinus position of the foot at initial contact. Both groups showed increased external extensor moments across the knee. The muscle-tendon lengths of the hamstrings were abnormally long at initial contact, and in both recurvatum groups, contracted faster compared with the control group. Surface electromyography revealed prolonged activity of the hamstrings in stance and early activation in swing. Abnormally long hamstrings at initial contact together with equinus position of the foot are the main causes of genu recurvatum in children with CP.
MeSH term(s)	Biomechanical Phenomena ; Cerebral Palsy/complications ; Cerebral Palsy/pathology ; Cerebral Palsy/physiopathology ; Child ; Electromyography ; Equinus Deformity/etiology ; Equinus Deformity/pathology ; Equinus Deformity/physiopathology ; Female ; Gait/physiology ; Humans ; Joint Instability ; Knee Joint ; Male ; Muscle, Skeletal/pathology ; Muscle, Skeletal/physiopathology ; Tendons/pathology ; Tendons/physiopathology
Language	English
Publishing date	2010-07
Publishing country	United States
Document type	Journal Article
ISSN	1473-5865
ISSN (online)	1473-5865
DOI	10.1097/BPB.0b013e32833822d5
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Article ; Online: Genu recurvatum in cerebral palsy--part A: influence of dynamic and fixed equinus deformity on the timing of knee recurvatum in children with cerebral palsy.

Svehlík, Martin / Zwick, Ernst B / Steinwender, Gerhardt / Saraph, Vinay / Linhart, Wolfgang E

Journal of pediatric orthopedics. Part B

2010 Volume 19, Issue 4, Page(s) 366–372

Abstract: The aim of the study was to confirm the hypothesis of the influence of the dynamic and fixed equinus deformity on the timing of knee recurvation (hyperextension). According to our hypothesis, dynamic equinus is linked to early and fixed equinus and to ... ...

Abstract	The aim of the study was to confirm the hypothesis of the influence of the dynamic and fixed equinus deformity on the timing of knee recurvation (hyperextension). According to our hypothesis, dynamic equinus is linked to early and fixed equinus and to late knee hyperextension. A group 35 children with cerebral palsy (47 lower limbs) was divided into two subgroups according to the timing of maximum knee hyperextension. Clinical examination confirmed our hypothesis. Gait analysis and musculoskeletal modelling results were compared with 12 normally developing children. Both recurvatum groups had forefoot landing and neither achieved normal ankle dorsiflexion. Electromyographic examination revealed an abnormally high soleus activity in a single stance. Muscle length changes of medial gastrocnemius and soleus were in agreement with our hypothesis. Such a finding might simplify the decision as to which treatment to select for equinus deformity, present in patients with genu recurvatum.
MeSH term(s)	Biomechanical Phenomena ; Cerebral Palsy/complications ; Cerebral Palsy/physiopathology ; Child ; Electromyography ; Equinus Deformity/etiology ; Equinus Deformity/physiopathology ; Female ; Gait/physiology ; Humans ; Joint Instability ; Knee Joint/abnormalities ; Knee Joint/physiopathology ; Male ; Muscle, Skeletal/physiopathology ; Range of Motion, Articular ; Time Factors
Language	English
Publishing date	2010-07
Publishing country	United States
Document type	Journal Article
ISSN	1473-5865
ISSN (online)	1473-5865
DOI	10.1097/BPB.0b013e32833a5f72
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Article ; Online: Dynamic versus fixed equinus deformity in children with cerebral palsy: how does the triceps surae muscle work?

Svehlík, Martin / Zwick, Ernst B / Steinwender, Gerhard / Kraus, Tanja / Linhart, Wolfgang E

Archives of physical medicine and rehabilitation

2010 Volume 91, Issue 12, Page(s) 1897–1903

Abstract: Objectives: To detect outcome measures that could help differentiate between dynamic and fixed equinus (FEQ) deformities in children with cerebral palsy, and secondary, to describe the function of the gastrocnemius and soleus (SOL) muscles when either ... ...

Abstract	Objectives: To detect outcome measures that could help differentiate between dynamic and fixed equinus (FEQ) deformities in children with cerebral palsy, and secondary, to describe the function of the gastrocnemius and soleus (SOL) muscles when either dynamic triceps surae tightness or FEQ contracture is present. Design: A group-comparison study. Setting: Gait analysis laboratory. Participants: Children (N=23; 31 limbs) with cerebral palsy; 12 limbs showed a fixed contracture (FEQ group) and 19 limbs showed dynamic tightness of the triceps muscle (dynamic equinus group). Healthy children (N=12) without a neurologic or orthopedic disorder served as the control group. Interventions: Not applicable. Main outcome measures: Time-distance, kinematic and kinetic gait variables, muscle-tendon length, and velocity parameters. Results: Maximal ankle dorsiflexion angles were decreased in both equinus groups compared with the control group. Ankle range of motion, maximal power generation of the plantar flexors, and its timing during the gait cycle were different among groups. The ankle slope parameter showed substantial differences among groups. Muscle-tendon length parameters for the SOL and the medial (MGAC) and lateral gastrocnemius muscles were abnormal in both equinus groups compared with the control group. Maximal muscle lengths of the MGAC and SOL were longer in the dynamic equinus than FEQ group. Peak lengthening velocity of the triceps surae muscle was significantly slower for all triceps surae muscles in the FEQ group than in the dynamic equinus group and occurred in the early swing phase. Conclusions: The presented results indicate that peak lengthening velocity of the triceps surae muscle might be one of the discriminating factors between FEQ and dynamic equinus deformity in children with cerebral palsy. This could help clinical decision making for treatment of an equinus gait pattern.
MeSH term(s)	Analysis of Variance ; Biomechanical Phenomena ; Cerebral Palsy/physiopathology ; Child ; Equinus Deformity/physiopathology ; Gait Disorders, Neurologic/physiopathology ; Humans ; Muscle, Skeletal/physiopathology ; Software ; Video Recording
Language	English
Publishing date	2010-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2010.09.005
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Article ; Online: Comparison of Ponseti versus surgical treatment for idiopathic clubfoot: a short-term preliminary report.

Zwick, Ernst B / Kraus, Tanja / Maizen, Claudia / Steinwender, Gerhardt / Linhart, Wolfgang E

Clinical orthopaedics and related research

2009 Volume 467, Issue 10, Page(s) 2668–2676

Abstract: Unlabelled: The Ponseti method of treatment for congenital clubfeet has gained widespread clinical acceptance. We have used manipulation, serial casting, and surgery to treat congenital clubfeet for almost 3 decades. Considering the Ponseti method of ... ...

Abstract	Unlabelled: The Ponseti method of treatment for congenital clubfeet has gained widespread clinical acceptance. We have used manipulation, serial casting, and surgery to treat congenital clubfeet for almost 3 decades. Considering the Ponseti method of treatment to replace our traditional treatment method, we conducted a randomized, controlled trial evaluating the short-term outcome of the two treatment protocols. We evaluated foot function and applied a standardized measure of health status for children with orthopaedic problems. Nineteen patients (28 feet) were included in the trial. Nine infants (12 feet) were assigned to the Ponseti treatment group, and 10 (16 feet) were assigned to a group with initial casting and posteromedial release at the age of 6 to 8 months. The minimum followup was 3.3 years (mean, 3.5 years; range 3.3-3.8 years). Outcome measures included the Functional Rating System of Laaveg and Ponseti, the Pediatric Outcomes Data Collection Instrument (PODCI), and standardized radiographic measurements. At last followup the mean Functional Rating score was higher in the Ponseti group. Passive dorsiflexion and passive inversion-eversion were better in the Ponseti group. PODCI scales were comparable and radiographic outcome measures were similar in both groups. This trial has documented a favorable short-term outcome for the Ponseti method when compared with a traditional treatment protocol. Level of evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
MeSH term(s)	Activities of Daily Living ; Casts, Surgical ; Child, Preschool ; Clubfoot/diagnostic imaging ; Clubfoot/physiopathology ; Clubfoot/surgery ; Clubfoot/therapy ; Female ; Humans ; Infant ; Male ; Orthopedic Procedures ; Patient Satisfaction ; Physical Therapy Modalities ; Pilot Projects ; Prospective Studies ; Radiography ; Recovery of Function ; Severity of Illness Index ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2009-04-07
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1007/s11999-009-0819-5
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Article ; Online: No adverse affect after harvesting of free fibula osteoseptocutaneous flaps on gait function.

Maurer-Ertl, Werner / Glehr, Mathias / Friesenbichler, Joerg / Sadoghi, Patrick / Wiedner, Maria / Haas, Franz / Leithner, Andreas / Windhager, Reinhard / Zwick, Ernst B

Microsurgery

2012 Volume 32, Issue 5, Page(s) 364–369

Abstract: The aim of this study was to analyze gait function and muscular strength on donor site after harvesting of a vascularized fibula osteoseptocutaneous flap. Nine patients with a mean follow-up of 33 months (range, 7-59) and a mean resection length of the ... ...

Abstract	The aim of this study was to analyze gait function and muscular strength on donor site after harvesting of a vascularized fibula osteoseptocutaneous flap. Nine patients with a mean follow-up of 33 months (range, 7-59) and a mean resection length of the middle portion of the fibula of 18.0 cm (range, 14.0-23.0) underwent an instrumented three-dimensional gait analysis to evaluate gait function. Furthermore, CYBEX II extremity system was used for muscular strength measurements. Subjective muscle strength measurements were performed according to Kendall et al. and were classified according to the British Medical Research Council. Intraindividual comparison between the operated and the nonoperated leg revealed no significant differences for gait function parameters (cadence, velocity, and stride length, P > 1.00) and for muscular strength measurements for flexion (knee: P = 0.93, ankle: P = 0.54) and extension (knee: P = 0.97, ankle: P= 0.21), respectively. In conclusion, intraindividual comparison of the operated and nonoperated sides after harvesting of the middle portion of the fibula for gaining a free fibula osteoseptocutaneous flap has no adverse affect on gait function or muscular flexion and extension strength on donor site at a mean follow-up of 33 months.
MeSH term(s)	Adolescent ; Adult ; Ankle/physiology ; Female ; Fibula/transplantation ; Follow-Up Studies ; Free Tissue Flaps ; Gait ; Humans ; Male ; Middle Aged ; Muscle Strength ; Muscle Strength Dynamometer ; Tissue and Organ Harvesting/adverse effects ; Young Adult
Language	English
Publishing date	2012-07
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	605524-2
ISSN	1098-2752 ; 0738-1085
ISSN (online)	1098-2752
ISSN	0738-1085
DOI	10.1002/micr.21959
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