When bone has been severely weakened by chronic infection,
it may be necessary to provide support for it with plates and pins or bone
grafts in order to avoid repeated fractures and to allow normal function. Scoliosis
mean abnormal curvature of the spine. A minor degree of it is present in a
large proportion of all people, in whom it is usually barely noticeable and
does not interfere with posture and function.
Two important causes of severe
scoliosis in the past-polio and tuberculosis-have been minimized in recent years.
Polio may lead to scoliosis if muscles on one side of the body are weakened to
a greater extent than on the other side. When this occurs, the stronger muscles
pull harder on the spine than the weaker ones, leading to curvature.
Tuberculosis may affect the spine, leading to an imbalance of the bony spinal
column. Scoliosis may be the result of a congenital defect, such as absence of
half of a vertebra. It may develop for unknown reasons, usually between the
ages of 5 and 15, and most often in girls. Sometimes, unequal leg length or
faulty function of a hip joint can unbalance the spine, leading to curvature.
Scoliosis can progress rapidly, particularly the type that affects young girls.
Therefore, it should be brought to a physician's attention as soon as possible.
The physician is most concerned about whether the curvature is progressing, and
if so how fast. If the cause of the scoliosis is unequal leg length,
treatment may require nothing more than use of a shoe lift for the shorter
leg. Most cases of scoliosis are minor and require little if any treatment.
But when treatment is needed, it should be supervised by a
specialist in bone problems, an orthopedist. X-ray studies of the spine with
careful measurement of the degree of curvature is an important step in
evaluation of the scoliosis. If the scoliosis is of the type which, if
unchecked, may progress to become a serious deformity, it may not only
interfere with normal posture and gait but also lead eventually to compromising
of lung function, since the chest wall on one side may be compressed. Treatment
should be begun without delay.
The further the spine
is deformed, the longer corrective measure will be needed. Recent advances
have made treatment of scoliosis more effective and less inconvenient as well.
The Milwaukee brace, a device designed to gradually reposition the curved
spine, is particularly effective. It is essential that an experienced
technician measure and fit the brace and an orthopedist supervise the wearing.
Another method of treatment is to cast the spine so as to gently nudge it into
normal position. Most children adapt readily to several months of treatment
with brace or cast. Surgery may be avoided in this way.
With age, the spinal
column becomes less pliable and bracing or casting may be insufficient to
correct a deformity. Several surgical procedures are of value. One of the most
outstanding is the insertion of special rods, called Harrington rods, in the
back muscles, one on either side of and connected to the spinal column. One rod
pushes up on the shortened side of the spine while the other pulls the longer
side.
Once the spine is correctly aligned, surgical fusion ofbones of the spine secures the alignment. Sometimes, however, as in many fractures of
hip, forearm, and upper arm, extra support may be needed to insure that the
bone knits together. Such support may be provided by operative placement of
plates and screws or nails, or occasionally by bone grafts. Simple fractures
can often be treated by a general practitioner. But most fractures should be
evaluated and treated by an orthopedist, who will decide on the need for
operative or non-operative measures.
Bone requires six or more weeks to heal, and during this
time proper alignment is maintained by a plaster cast. Although the fractured
bone must be immobilized if it is to heal properly, muscles that normally move
the immobilized part must be kept limber and strong. Special exercises achieve
this. Doctors also pay close attention to the cast itself, making certain it is
neither too snug nor too loose. Too tight a fit can lead to compression of theblood supply to the extremity.
Fingertips and toes are left uncovered by a cast
so the physician can judge the status of blood supply from skin color. Too
loose a fit of the cast can allow movement of the fractured bone and
misalignment. X-rays after application of the cast can be used to check proper
alignment. As mentioned earlier, prolonged immobilization weakens bone andmuscle. Therefore, return to normal functioning as soon as possible is
encouraged.
