New Frontiers in Orthopedic Surgery

Prof. Nicola Portinaro
Surgeon specialized in Traumatology, Pediatric Orthopedics and Neuro Orthopedics

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Early Surgery for pediatric patients Nicola Portinaro

THE PROJECT

Prof. Nicola Portinaro has been adopting a unique treatment protocol for children affected by neuromotor disorders since 2004. It is called Early Multilevel Minimally-invasive Approach. A study of this approach adopted for developmental dysplasia of the spastic hip in cerebral palsy was published in 2009 in the magazine Hip International.

It is a Minimally-invasive and Early Multilevel surgical approach to recover the motor function of children with neuro-motor diseases and reduce the evolution of these diseases in structured musculotendinous and osteoarticular deformities.
This approach is applied to all the motor districts such as knee, ankle, foot and also to the whole upper limb.
Until a few years ago, surgery aimed to lengthen tendons and muscles that over time contracted again.
Now we try to avoid surgery on noble tissues such as tendon and muscle but we act by “sliding” them one on the other to obtain a biomechanical elongation-adaptation.
This leads to an improvement of the force and power curves and allows to exploit muscles that work incorrectly and inadequately.
After a careful clinical evaluation, it is possible to chart a specific treatment plan which is optimized for every child.
The clinical assessment is aimed to determine:

the range of movement of each joint

the strength and resistance of the muscles

the ability to perform a specific and precise voluntary movement

an instrumental evaluation of the deformities of the musculoskeletal system

Furthermore, in collaboration with the Divieti laboratory of the Politecnico, University of Milan, young patients are also studied from a dynamic point of view, using the most recent kinetics and kinematics gait analysis. The walk on platforms that allow quantifying the movement and the strength of the various joints and muscles and the extent of the deformities.
In this way, it is possible to get a complete clinical picture of the motor potential. Thanks to this analysis it is possible to perform a targeted surgery that allows improving the motor potential of children in a substantial and radical way.

Read abstract: D.D.S.H .: developmental dysplasia of the spastic hip: strategies of management in cerebral palsy. A new suggestive algorithm

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Prof Nicola Portinaro

Il Professor Portinaro è un chirurgo ortopedico pediatrico tra i massimi esperti, in particolare, per la cura di problemi ortopedici di anche, piedi, ginocchia e per tutte le patologie neuro ortopediche. È Senior Consultant di Ortopedia e Neuro-Ortopedia pediatrica presso la FONDAZIONE IRCCS CA’ GRANDA OSPEDALE MAGGIORE POLICLINICO e presso l’Humanitas Research Hospital. È inoltre e professore di Ortopedia e Traumatologia presso la Facoltà di Medicina e Chirurgia dell’Università degli Studi di Milano.