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A 4-year-old girl with an L3 myelomeningocele presents for routine follow-up. Pelvic radiographs reveal a complete dislocation of the left hip with well formed acetabulum, and a normal right hip. Her gait is symmetric with use of a walker and brace. Which of the treatment options should be offered to the patient at this time?
Right sided femoral shortening osteotomy
Continued observation and routine follow-up
Left greater trochanteric advancement
Left sided pelvic osteotomy
Open reduction of the left hip
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The addition of which of the following food supplements may lead to a decrease in neural tube defects?
An 18-year-old ambulatory female with spina bifida presents with a painful planovalgus left foot. She has failed treatment with orthoses and heel-cord stretching regimens. Ankle radiographs demonstrate that the distal tibia is tilted 15° into valgus relative to the long axis. Which of the following treatment options would best correct the deformity?
Triple arthrodesis of the ankle
Medial tibial epiphysiodesis
Calcaneal lengthening osteotomy and tendo-Achilles lengthening
Midfoot osteotomy combined with plantar release
A 6-year-old boy with spina bifida presents to your clinic with a progressive foot deformity. He can walk independently and ankle dorsiflexion and toe extension demonstrate full strength. He has a bulky, hypertrophied heel pad, but no open ulceration. Foot radiographs are displayed in Figure A. What myelomeningocele level does this patient have and what surgical procedure is indicated for the foot?
L1 level requiring triple arthrodesis
L3 level requiring triple arthrodesis
L3 level requiring posterior transfer of the anterior tibial tendon
L5 level requiring triple arthrodesis
L5 level requiring posterior transfer of the anterior tibial tendon
Patients with myelomeningocele have an allergic response (type 1 hypersensitivity) to latex by what cellular mechanism?
Overactive complement system
Hyperactive killer-T cells
An 18-month-old infant with myelomeningocele and rigid clubfeet has grade 5 quadriceps and hamstring strength, but no muscles are functioning below the knee. What is the best treatment option for the rigid clubfeet?
Soft-tissue releases as necessary
Tendon transfers to balance the feet in a neutral plantigrade position
Physical therapy for range of motion and stretching
Botulinum injections followed by serial casting
A newborn with myelomeningocele has no movement below the waist and has bilateral hips that dislocate with provocative flexion and adduction. What is the best treatment option for the hip instability?
A Pavlik harness with the hips in 90 degrees of flexion and 60 degrees of abduction
A spica cast with the hips in 100 degrees of flexion and 70 degrees of abduction
Observation with range-of-motion exercises to minimize contractures
Open reduction through an anterior hip approach
Open reduction through a medial hip approach