Blog Elements - International Journal of Paediatric Orthopaedics

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Blount’s Disease: Review Article

Volume 10 | Issue 2 | May-August 2024 | Page: 24-33 | Yashwant Singh Tanwar, Sirazul Haque Malik, Karolina Siwicka, Nando Ferreira, Pieter Herman Maré DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.188 Submitted: 02/05/2024; Reviewed: 29/05/2024; Accepted: 21/06/2024; Published: 10/08/2024 Authors: Sudhanshu Yashwant Singh Tanwar MS Ortho., DNB, MRCS [1], Sirazul Haque Malik MS Ortho. [2], Karolina Siwicka MD, PhD […]

Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 09-13 | Jayanth Sampath, Taral Nagda DOI- https://doi.org/10.13107/ijpo.2024.v10i01.172 Submitted: 01/02/2024; Reviewed: 14/02/2024; Accepted: 18/03/2024; Published: 10/04/2024 Authors: Jayanth Sampath MS Ortho [1], Taral Nagda MS Ortho [2] [1] Department of Paediatric Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India. [2] Department of Paediatric Orthopaedics, SRCC NH […]

Blount’s Disease: Review Article

Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Full Sized Blog Element (Big Preview Pic)

Blount’s Disease: Review Article

Volume 10 | Issue 2 | May-August 2024 | Page: 24-33 | Yashwant Singh Tanwar, Sirazul Haque Malik, Karolina Siwicka, Nando Ferreira, Pieter Herman Maré

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.188

Submitted: 02/05/2024; Reviewed: 29/05/2024; Accepted: 21/06/2024; Published: 10/08/2024

Authors: Sudhanshu Yashwant Singh Tanwar MS Ortho., DNB, MRCS [1], Sirazul Haque Malik MS Ortho. [2], Karolina Siwicka MD, PhD (T & O) [3], Nando Ferreira FC Orth (SA), MMed (Orth), PhD [3], Pieter Herman Maré FC Orth (SA), PhD [4]
[1] Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi, India.
[2] Department of Orthopedics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, Uttarakhand, India.
[3] Division of Orthopedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa.
[4] Paediatric Orthopaedics Unit, Grey’s Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.

Address of Correspondence

Dr. Yashwant Singh Tanwar
Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi, India.
E-mail: tanwar_yashwant@yahoo.co.in

Abstract

Blount’s disease, or non-physiological idiopathic tibia vara, is a growth disturbance affecting the medial proximal tibial physis, leading to a progressive three-dimensional deformity characterized by varus, procurvatum, and internal rotation. While its precise etiology remains unclear, the condition has been closely linked to obesity, mechanical stress, and potential genetic predisposition. Infantile Blount’s typically presents between one and three years of age, often bilaterally, whereas late-onset forms occur in juveniles (4–10 years) or adolescents (>10 years) and are more commonly unilateral. Early differentiation from physiological bowing is essential, as untreated disease results in progressive deformity and joint instability.
Radiographic evaluation is critical in confirming the diagnosis and planning treatment. Key parameters, including the meta-diaphyseal (Drennan) angle, medial metaphyseal beak angle, and mechanical tibiofemoral axis deviation, provide objective measures to distinguish Blount’s disease from other causes of genu varum. Medial tibial plateau depression, best assessed using an arthrogram, is a key determinant in surgical planning, particularly in advanced cases.
Management strategies depend on the stage and severity of the disease. In early stages, guided growth using tension-band plating may modulate physeal development and prevent progression. However, in advanced or recurrent cases, surgical correction is required. Metaphyseal osteotomy, with or without internal fixation, remains the mainstay of treatment. In cases with significant medial plateau depression, a medial hemiplateau elevation osteotomy is indicated to restore joint congruency and knee stability. Severe or late-presenting cases may necessitate double osteotomy techniques, combining joint line realignment with metaphyseal correction. Acute correction methods, including oblique and dome osteotomies, are effective but carry risks of neurovascular compromise. In cases of complex multiplanar deformity, gradual correction using circular external fixation offers precise correction while minimizing complications.
Despite surgical intervention, recurrence remains a concern, particularly in cases with persistent medial physeal slope abnormalities. Strategies such as prophylactic lateral tibial and fibular epiphysiodesis, as well as controlled overcorrection, have been proposed to minimize recurrence risk. Perioperative considerations, including prophylactic fasciotomy and careful fibular osteotomy placement, play a role in preventing complications such as compartment syndrome and peroneal nerve palsy.
Blount’s disease is a progressive condition requiring early diagnosis and timely intervention to prevent long-term morbidity. A structured approach, incorporating clinical assessment, radiographic analysis, and stage-specific management, is essential to optimize outcomes. While current surgical techniques provide reliable correction, ongoing research into the pathophysiology and treatment of Blount’s disease remains essential to improving long-term prognosis.
Keywords: Blount’s disease, Infantile tibia vara, Adolescent tibia vara

References

1. Erlacher P. Deforming processes of the epiphyseal region in children. Arch Orthop trauma Surg. 1922;March(20):81–96.
2. W.P. Blount. Tibia vara: osteochondris deformans tibiae. J Bone Jt Surg. 1937;19:1–29.
3. LANGENSKIOLD A. Tibia vara; (osteochondrosis deformans tibiae); a survey of 23 cases. Acta Chir Scand. 1952 Mar 26;103(1):1–22.
4. LANGENSKIOELD A, RISKA EB. TIBIA VARA (OSTEOCHONDROSIS DEFORMANS TIBIAE): A SURVEY OF SEVENTY-ONE CASES. J Bone Joint Surg Am. 1964 Oct;46:1405–20.
5. Stricker SJ, Edwards PM, Tidwell MA. Langenskiöld Classification of Tibia Vara: An Assessment of Interobserver Variability. J Pediatr Orthop. 1994 Mar;14(2):152–5.
6. Sabharwal S, Zhao C, McClemens E. Correlation of body mass index and radiographic deformities in children with Blount disease. J Bone Joint Surg Am. 2007 Jun;89(6):1275–83.
7. ARKIN AM, KATZ JF. The effects of pressure on epiphyseal growth; the mechanism of plasticity of growing bone. J Bone Joint Surg Am. 1956 Oct;38-A(5):1056–76.
8. Mehtar M, Ramguthy Y, Firth G. Profile of patients with Blount’s disease at an academic hospital. SA Orthop J. 2091;18(9).
9. Muthuri SK, Francis CE, Wachira L-JM, Leblanc AG, Sampson M, Onywera VO, et al. Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review. PLoS One. 2014;9(3):e92846.
10. Montgomery CO, Young KL, Austen M, Jo C-H, Blasier RD, Ilyas M. Increased risk of Blount disease in obese children and adolescents with vitamin D deficiency. J Pediatr Orthop. 2010 Dec;30(8):879–82.
11. Lisenda L, Simmons D, Firth GB, Ramguthy Y, Kebashni T, Robertson AJF. Vitamin D Status in Blount Disease. J Pediatr Orthop. 2016;36(5):e59-62.
12. Jansen N, Hollman F, Bovendeert F, Moh P, Stegmann A, Staal HM. Blount disease and familial inheritance in Ghana, area cross-sectional study. BMJ Paediatr Open. 2021 Apr;5(1):e001052.
13. Feldman MD, Schoenecker PL. Use of the metaphyseal-diaphyseal angle in the evaluation of bowed legs. J Bone Jt Surg. 1993 Nov;75(11):1602–9.
14. Siffert RS, Katz JF. The intra-articular deformity in osteochondrosis deformans tibiae. J Bone Joint Surg Am. 1970 Jun;52(4):800–4.
15. Maré PH, Thompson DM, Marais LC. Predictive Factors for Recurrence in Infantile Blount Disease Treated With Tibial Osteotomy. J Pediatr Orthop. 2021 Jan;41(1):e36–43.
16. Sanghrajka AP, Hill RA, Murnaghan CF, Simpson AHRW, Bellemore MC. Slipped upper tibial epiphysis in infantile tibia vara. J Bone Joint Surg Br. 2012 Sep;94-B(9):1288–91.
17. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39–47.
18. Wongcharoenwatana J, Kaewpornsawan K, Chotigavanichaya C, Eamsobhana P, Laoharojanaphand T, Musikachart P, et al. Medial Metaphyseal Beak Angle as a Predictor for Langenskiöld Stage II of Blount’s Disease. Orthop Surg. 2020 Dec;12(6):1703–9.
19. Davids JR, Blackhurst DW, Allen BL. Radiographic evaluation of bowed legs in children. J Pediatr Orthop. 2001;21(2):257–63.
20. Gordon JE, King DJ, Luhmann SJ, Dobbs MB, Schoenecker PL. Femoral Deformity in Tibia Vara. J Bone Jt Surg. 2006 Feb;88(2):380–6.
21. Sabharwal S, Lee J, Zhao C. Multiplanar Deformity Analysis of Untreated Blount Disease. J Pediatr Orthop. 2007 Apr;27(3):260–5.
22. Sabharwal S. Blount Disease. Orthop Clin North Am. 2015 Jan;46(1):37–47.
23. Robbins CA. Deformity Reconstruction Surgery for Blount’s Disease. Child (Basel, Switzerland). 2021 Jun 30;8(7).
24. Edwards TA, Hughes R, Monsell F. The challenges of a comprehensive surgical approach to Blount’s disease. J Child Orthop. 2017 Dec 1;11(6):479–87.
25. Jain MJ, Inneh IA, Zhu H, Phillips WA. Tension Band Plate (TBP)-guided Hemiepiphysiodesis in Blount Disease: 10-Year Single-center Experience With a Systematic Review of Literature. J Pediatr Orthop. 2020 Feb;40(2):e138–43.
26. Maré PH, Thompson DM, Marais LC. Guided growth using a tension-band plate in Blount’s disease. J Pediatr Orthop B. 2022 Mar 1;31(2):120–6.
27. Stevens PM. Guided growth for deformity correction. Oper Tech Orthop. 2011;21:197–202.
28. LaMont LE, McIntosh AL, Jo CH, Birch JG, Johnston CE. Recurrence After Surgical Intervention for Infantile Tibia Vara: Assessment of a New Modified Classification. J Pediatr Orthop. 2019 Feb;39(2):65–70.
29. Adulkasem N, Wongcharoenwatana J, Ariyawatkul T, Chotigavanichaya C, Eamsobhana P. A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy. J Pediatr Orthop. 2023 Apr;43(4):e299–304.
30. Andrade N, Johnston CE. Medial epiphysiolysis in severe infantile tibia vara. J Pediatr Orthop. 2006;26(5):652–8.
31. Eamsobhana P, Kaewpornsawan K, Yusuwan K. Do we need to do overcorrection in Blount’s disease? Int Orthop. 2014 Aug;38(8):1661–4.
32. Maré PH, Thompson DM, Marais LC. Growth modulation may decrease recurrence when used as an adjunct to osteotomy in infantile Blount’s disease. SA Orthop J [Internet]. 2021 [cited 2024 Aug 31];20(2):88–92. Available from: http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2021000200007&lng=en&nrm=iso&tlng=en
33. Baraka MM, Hefny HM, Mahran MA, Fayyad TA, Abdelazim H, Nabil A. Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount’s disease: a new technique. J Child Orthop. 2021 Feb 1;15(1):12–23.
34. Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB. Accuracy of Correction of Tibia Vara. J Pediatr Orthop. 2006 Nov;26(6):794–8.
35. Nada AA, Hammad ME, Eltanahy AF, Gazar AA, Khalifa AM, El-Sayed MH. Acute Correction and Plate Fixation for the Management of Severe Infantile Blount’s Disease: Short-term Results. Strateg trauma limb Reconstr. 2021;16(2):78–85.
36. Griswold B, Gilbert S, Khoury J. Opening Wedge Osteotomy for the Correction of Adolescent Tibia Vara. Iowa Orthop J. 2018;38:141–6.
37. Mare PH, Marais LC. Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount’s Disease. Strateg Trauma Limb Reconstr. 2022 May 24;17(1):32–7.
38. Maré P, Thompson D. Infantile Blount’s disease. SA Orthop J. 2020;19(3).
39. Craig JG, van Holsbeeck M, Zaltz I. The utility of MR in assessing Blount disease. Skeletal Radiol. 2002 Apr;31(4):208–13.
40. Maré PH, Thompson DM, Marais LC. The Medial Elevation Osteotomy for Late-presenting and Recurrent Infantile Blount Disease. J Pediatr Orthop. 2021 Feb;41(2):67–76.
41. van Huyssteen AL, Hastings CJ, Olesak M, Hoffman EB. Double-elevating osteotomy for late-presenting infantile Blount’s disease. J Bone Joint Surg Br. 2005 May;87-B(5):710–5.
42. Rab GT. Oblique tibial osteotomy for Blount’s disease (tibia vara). J Pediatr Orthop [Internet]. 1988/11/01. 1988;8(6):715–20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3192702
43. Rab GT. Oblique tibial osteotomy revisited. J Child Orthop [Internet]. 2010/03/18. 2010;4(2):169–72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20234769
44. Dilawaiz Nadeem R, Quick TJ, Eastwood DM. Focal dome osteotomy for the correction of tibial deformity in children. J Pediatr Orthop B. 2005 Sep;14(5):340–6.
45. Miraj F, Ajiantoro, Arya Mahendra Karda IW. Step cut “V” osteotomy for acute correction in Blount’s disease treatment: A case series. Int J Surg Case Rep. 2019;58:57–62.
46. Phedy P, Siregar PU. Osteotomy for deformities in blount disease: A systematic review. J Orthop. 2016 Sep;13(3):207–9.
47. Karuppal R, Mohan R, Marthya A, Ts G, S S. Case Report: “Z” osteotomy – a novel technique of treatment in Blount’s disease. F1000Research. 2015;4:1250.
48. Khermosh O, Wientroub S. Serrated (W/M) osteotomy: a new technique for simultaneous correction of angular and torsional deformity of the lower limb in children. J Pediatr Orthop B. 1995;4(2):204–8.
49. Gkiokas A, Brilakis E. Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation. J Child Orthop. 2012 Oct;6(5):411–8.
50. Gbenou AS, Assan BR, Houegban ASCR, Fiogbe MA. Compartment syndrome following an acute correction of a neglected case of Blount’s disease: What lessons can be learned? J Orthop Reports. 2022 Dec;1(4):100079.
51. Cometa MA, Esch AT, Boezaart AP. Did continuous femoral and sciatic nerve block obscure the diagnosis or delay the treatment of acute lower leg compartment syndrome? A case report. Pain Med. 2011 May;12(5):823–8.
52. Greene WB. Infantile tibia vara. J Bone Jt Surg. 1993 Jan;75(1):130–43.
53. Birch JG. Blount Disease. J Am Acad Orthop Surg. 2013 Jul 1;21(7):408–18.
54. McCarthy JJ, MacIntyre NR, Hooks B, Davidson RS. Double Osteotomy for the Treatment of Severe Blount Disease. J Pediatr Orthop. 2009 Mar;29(2):115–9.
55. Hefny H, Shalaby H, El-kawy S, Thakeb M, Elmoatasem E. A New Double Elevating Osteotomy in Management of Severe Neglected Infantile Tibia Vara using the Ilizarov Technique. J Pediatr Orthop. 2006 Mar;26(2):233–7.
56. Bar-On E, Weigl DM, Becker T, Katz K. Treatment of severe early onset Blount’s disease by an intra-articular and a metaphyseal osteotomy using the Taylor Spatial Frame. J Child Orthop. 2008 Dec 1;2(6):457–61.
57. Cerqueira F dos S, Motta GATA, Rocha de Faria JL, Pizzolatti IS, Motta DP da, Mandarino M, et al. Controlled Double Gradual Opening Osteotomy for the Treatment of Severe Varus of the Knee—Blount’s Disease. Arthrosc Tech. 2021 Sep;10(9):e2199–206.
58. Jones S, Hosalkar HS, Hill RA, Hartley J. Relapsed infantile Blount’s disease treated by hemiplateau elevation using the Ilizarov frame. J Bone Joint Surg Br. 2003 May;85-B(4):565–71.
59. Tavares JO, Molinero K. Elevation of medial tibial condyle for severe tibia vara. J Pediatr Orthop B. 2006 Sep;15(5):362–9.
60. Haddad FS, Harper GD, Hill RA. Intraoperative Arthrography and the Ilizarov Technique. J Bone Jt Surg. 1997 Sep 1;79(5):731–3.
61. Stanitski DF, Stanitski CL, Trumble S. Depression of the Medial Tibial Plateau in Early-Onset Blount Disease: Myth or Reality? J Pediatr Orthop. 1999 Mar;19(2):265–9.

How to Cite this Article: Tanwar YS, Malik SH, Siwicka K, Ferreira N, Maré PH | Blount’s Disease: Review Article | International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 24-33. https://doi.org/10.13107/ijpo.2024.v10.i02.188

(Article Text HTML) (Full Text PDF)

Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 09-13 | Jayanth Sampath, Taral Nagda

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.172

Submitted: 01/02/2024; Reviewed: 14/02/2024; Accepted: 18/03/2024; Published: 10/04/2024

Authors: Jayanth Sampath MS Ortho [1], Taral Nagda MS Ortho [2]

[1] Department of Paediatric Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.
[2] Department of Paediatric Orthopaedics, SRCC NH Children’s Hospital, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: jayanthdoc@gmail.com

Abstract

Levers in the human body play an important role in facilitating efficient movement. Muscle forces act around the axis of movement of adjacent joints. The normal moment of a joint (M) is the product of the muscle force (F) and the length of lever arm (d). The primary neurological insult in cerebral palsy (CP) causes shortening of muscles, joint contractures, and torsional abnormalities in bones. The resulting ineffective lever arm leads to a failure to produce an appropriate torque and subsequent gait abnormalities. Therefore, the effects of lever arm dysfunction should be considered when gait improvement surgery is being offered to children with CP. This review will explain the role of levers in normal human biomechanics and the significance of lever arm dysfunction in the management of CP.
Keywords: Biomechanics, Lever arm, Disorder, Cerebral palsy

References

1. Gage JR, editor. The treatment of gait problems in cerebral palsy. 2nd ed. London: Mac Keith Press; 2004. Treatment principles for crouch gait; p 382-97.
2. Theologis T. Lever arm dysfunction in cerebral palsy gait. J Child Orthop. 2013;7(5):379-382.
3. Kalkman BM, Bar-On L, Cenni F, et al. Achilles tendon moment arm length is smaller in children with cerebral palsy than in typically developing children. J Biomech. 2017;56:48-54.
4. Õunpuu S, Solomito M, Bell K, Pierz K. Long-term outcomes of external femoral derotation osteotomies in children with cerebral palsy. Gait Posture. 2017;56(March 2016):82-88..
5. Kim HY, Cha YH, Chun YS, Shin HS. Correlation of the torsion values measured by rotational profile, kinematics, and CT study in CP patients. Gait Posture. 2017;57:241-245.
6. Saglam Y, Ekin Akalan N, Temelli Y, Kuchimov S. Femoral derotation osteotomy with multi-level soft tissue procedures in children with cerebral palsy: Does it improve gait quality? J Child Orthop. 2016;10(1):41-48.
7. Kadhim M, Miller F. Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. Gait Posture. 2014;39(2):793-798.
8. Kadhim M, Holmes L, Miller F. Long-term Outcome of Planovalgus Foot Surgical Correction in Children with Cerebral Palsy. J Foot Ankle Surg. 2013;52(6):697-703.
9. Kim HT, Jang JH, Ahn JM, Lee JS, Kang DJ. Early results of one-stage correction for hip instability in cerebral palsy. Clin Orthop Surg. 2012;4(2):139-148.
10. Ganjwala D. Multilevel orthopedic surgery for crouch gait in cerebral palsy: An evaluation using functional mobility and energy cost. Indian J Orthop. 2011;45(4):314..
11. Foroohar A, McCarthy JJ, Yucha D, Clarke S, Brey J. Head-shaft angle measurement in children with cerebral palsy. J Pediatr Orthop. 2009;29(3):248-250.
12. Rethlefsen SA. Causes of Intoeing Gait in Children with Cerebral Palsy. J Bone Jt Surg. 2006;88(10):2175..
13. Čobeljić G, Djorić I, Bajin Z, Despot B. Femoral derotation osteotomy in cerebral palsy: Precise determination by tables. Clin Orthop Relat Res. 2006;(452):216-224.
14. Kadhim M, Holmes L, Church C, Henley J, Miller F. Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy. J Child Orthop. 2012;6(3):217-227.
15. Aiona M, Calligeros K, Pierce R. Coronal plane knee moments improve after correcting external tibial torsion in patients with cerebral palsy. Clin Orthop Relat Res. 2012;470(5):1327-1333.
16. Davids JR, Gibson TW, Pugh LI, Hardin JW. Proximal femoral geometry before and after varus rotational osteotomy in children with cerebral palsy and neuromuscular hip dysplasia. J Pediatr Orthop. 2013;33(2):182-189.
17. Rodda JM, Sciences H. Severe Crouch Gait in the Sagittal Gait Patterns of Spastic Diplegic Cerebral Palsy : the Impact of Single Event Multilevel Surgery. 2005;(November).
18. Inan M, Altinta F, Duru I. The evaluation and management of rotational deformity in cerebral palsy. Acta Orthop Traumatol Turc. 2009;43(2):106-112.
19. Heimkes B, Stotz S, Heid T. Pathogenesis and prevention of spastic hip dislocation. Z Orthop Ihre Grenzgeb. 1992;130(5):413-418.
20. Pirpiris M, Trivett A, Baker R, Rodda J, Nattrass GR, Graham HK. Femoral derotation osteotomy in spastic diplegia. J Bone Jt Surg. 2003;85(2):265-272.

How to Cite this Article: Sampath J, Nagda T | Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy | International Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 09-13 . https://doi.org/10.13107/ijpo.2024.v10i01.172

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Blount’s Disease: Review Article

Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Blount’s Disease: Review Article

Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Full Sized Blog Element (Big Preview Pic)

Blount’s Disease: Review Article

Abstract

(Article Text HTML) (Full Text PDF)

Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Abstract

(Article Text HTML) (Full Text PDF)

License

Publisher