Publications by authors named "Soon Ghee Ang"

4 Publications

  • Page 1 of 1

Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy.

Dev Med Child Neurol 2016 Dec 17;58(12):1273-1280. Epub 2016 Jun 17.

Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.

Aim: We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function.

Method: Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS).

Results: Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain.

Interpretation: Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain.
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http://dx.doi.org/10.1111/dmcn.13171DOI Listing
December 2016

The impact of complementary and alternative medicine on hip development in children with cerebral palsy.

Dev Med Child Neurol 2013 May 22;55(5):472-9. Epub 2013 Feb 22.

Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.

Aim: This study aimed to evaluate the effect of complementary and alternative medicine (CAM) approaches on long-term surgical requirements, and clinical and radiographic outcomes for children with cerebral palsy and hip displacement.

Method: Twenty-three children with cerebral palsy and early hip displacement who were offered preventive hip surgery and whose parents declined in favour of CAM approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo]; mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia, two with spastic triplegia, and four with spastic diplegia; three with gross motor function classified at Gross Motor Function Classification System [GMFCS] level II, four at level III, six at level IV, and 10 at level V). Principal outcome measures were progression of hip displacement (measured by migration percentage: the percentage of the femoral head sitting outside of the acetabulum), eventual need for reconstructive or salvage surgery, and long-term hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification Scale). The results were compared with a previously reported cohort of 46 children who had surgery when recommended (31 males, 15 females; mean age 13 y 11 mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36 with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and 12 at level V).

Results: Outcomes for 23 children who had pursued CAM were analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20 children with documented progressive hip displacement, eight developed pain and deformity requiring salvage surgery. An additional 11 children with progressive hip displacement had late reconstructive surgery when symptoms first started. There was strong evidence of a relationship between GMFCS and both progressive hip displacement (χ(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip Classification Scale grade (odds ratio 12.5; p=0.012; 95% confidence interval 1.7-90.4). There was also evidence of those children who pursued CAM requiring more complex surgery than the group who had surgery when recommended (odds ratio 2.5; p=0.002; 95% confidence interval 1.4-4.5).

Interpretation: CAM therapy did not appear to influence the progression of hip displacement in children with cerebral palsy. Most children required major reconstructive surgery or salvage surgery despite pursuing CAM.
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http://dx.doi.org/10.1111/dmcn.12094DOI Listing
May 2013

The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy.

Dev Med Child Neurol 2012 Aug 12;54(8):743-7. Epub 2012 Jun 12.

Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.

Aim: To study the long-term impact of 3 years of botulinum toxin A (BoNT-A) injections and abduction bracing on hip development in children with bilateral spastic cerebral palsy (CP). We wanted to know if early treatment improved hip development and reduced the need for surgery.

Method: A long-term review of hip morphology and surgery requirements in children who participated in a multicentre, randomized controlled trial. The trial investigated short-term effects of BoNT-A injections combined with an abduction brace, compared with usual care, on hip displacement in children with bilateral spastic CP.

Results: Forty-six children with bilateral spastic CP (31 males, 15 females; 10 with diplegia, 36 with quadriplegia; mean age at enrolment of 3 y 2 mo, mean age at most recent clinical review 13 y 11 mo [range 10 y 6 mo-16 y 8 mo]; three children in Gross Motor Function Classification System level II, 11 in level III, 20 in level IV, 12 in level V) were followed for a mean of 10 years 10 months from recruitment to the trial. Mean migration percentage was 15.9% in the BoNT-A group and 15.2% in the comparison group (t = 0.26, p = 0.79). Eighty-nine percent of hips in the treatment group and 91% hips in the comparison group had satisfactory development, using a valid scale (Mann-Whitney U test = 867.50, z = -1.59, p = 0.11). Forty children had preventive surgery (21 treatment group, 19 comparison group) and 18 children had reconstructive surgery (10 treatment, 8 comparison).

Interpretation: In children with bilateral spastic CP, early treatment with BoNT-A and hip abduction bracing does not reduce the need for surgery or improve hip development at skeletal maturity.
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http://dx.doi.org/10.1111/j.1469-8749.2012.04340.xDOI Listing
August 2012

Comparative anatomical study of the gracilis and coracobrachialis muscles: implications for facial reanimation.

Plast Reconstr Surg 2003 Jul;112(1):20-30

Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Royal Melbourne Hospital, Australia.

Since the introduction of cross-facial nerve grafting and free vascularized muscle transfer for the treatment of longstanding facial paralysis, substantial progress has been made toward restoration of facial expression that is as normal as possible. Much of the focus has remained on the gracilis as a donor muscle. However, its inherent anatomical characteristics may preclude it from ever being more than simply a mass of contractile tissue in the face. The coracobrachialis muscle, which is the analogue in the arm of the lower limb adductor mass, was proposed as an alternative donor muscle because it was thought that certain features would allow it to improve on the overall results that are currently possible with the gracilis. A comparative anatomical study was conducted to gauge this potential. A total of 133 muscles were analyzed, including 96 dissected specimens, 16 arterial and 14 venous study specimens, and seven neurovascular study specimens. Anatomical parameters were recorded for each muscle and later tabulated. Histological analysis of the nerves to 10 gracilis and 10 coracobrachialis muscles was performed, and the findings were confirmed with intraneural dissection of an additional 20 nerves under an operating microscope. The coracobrachialis was observed to be a practical alternative to the gracilis. Indeed, it has many of the attributes that initially drew attention to the gracilis as a possible donor muscle, including a reliable neurovascular supply, minimal donor-site morbidity, and the option of having two teams operate simultaneously. In addition, it has a size, shape, and form that make it an excellent choice for transfer to the face. It could be easily attached in the face to provide static support as well as animation, because of its long proximal tendon, the thick intermuscular septum along its lateral surface, and, when present, the ligament of Struthers.
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http://dx.doi.org/10.1097/01.PRS.0000065909.86735.F7DOI Listing
July 2003
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