{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:43:45Z","timestamp":1792082625351,"version":"4.4.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"6_suppl","license":[{"start":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:00:00Z","timestamp":1230768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIP International"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:p>Hip problems in cerebral palsy are relatively frequent (25\u201375%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity.<\/jats:p>\n                  <jats:p>The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%.<\/jats:p>\n                  <jats:p>We consider age and R.I crucial prerequisites for treatment steps.<\/jats:p>\n                  <jats:p>EMMA 1) age 2\u20134 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures).<\/jats:p>\n                  <jats:p>EMMA 2) age 4\u20136, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction).<\/jats:p>\n                  <jats:p>EMMA 3) early bone surgery (growth plates).<\/jats:p>\n                  <jats:p>This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity.<\/jats:p>","DOI":"10.1177\/112070000901906s12","type":"journal-article","created":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T11:54:23Z","timestamp":1516967663000},"page":"69-74","source":"Crossref","is-referenced-by-count":15,"title":["D.D.S.H.: Developmental Dysplasia of the Spastic Hip: Strategies of Management in Cerebral Palsy. A New Suggestive Algorithm"],"prefix":"10.1177","volume":"19","author":[{"given":"N.","family":"Portinaro","sequence":"first","affiliation":[{"name":"University of Milan, Clinical Institute Humanitas, Rozzano - Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Panou","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedic Surgery, Clinical Institute Humanitas, Rozzano - Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Gagliano","sequence":"additional","affiliation":[{"name":"Department of Human Morphology, University of Milan - Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Pelillo","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedic Surgery, Clinical Institute Humanitas, Rozzano - Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,1,26]]},"reference":[{"key":"bibr1-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B8.11266"},{"key":"bibr2-112070000901906s12","unstructured":"CampbellA.G.M., McIntoshN. eds. Forfar and Arneil's textbook of paediatrics. Edinburg: Churchill Livingstone, 1998; 738."},{"key":"bibr3-112070000901906s12","first-page":"121","volume":"88","author":"Soo B.","year":"2006","journal-title":"J Bone Joint Surg (Am)"},{"key":"bibr4-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162201001086"},{"key":"bibr5-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197254040-00017"},{"key":"bibr6-112070000901906s12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/00003086-198009000-00025","volume":"151","author":"Tylkowski C.M.","year":"1980","journal-title":"Clin Orthop"},{"key":"bibr7-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01416"},{"key":"bibr8-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.84B5.12398"},{"key":"bibr9-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B1.15146"},{"key":"bibr10-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.67B4.4030844"},{"key":"bibr11-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1097\/00004694-199709000-00001"},{"key":"bibr12-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1136\/adc.76.4.381"},{"key":"bibr13-112070000901906s12","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/00003086-198303000-00022","volume":"173","author":"Pritchett J.W.","year":"1983","journal-title":"Clin Orthop"},{"key":"bibr14-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-198609000-00001"},{"key":"bibr15-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200209000-00017"},{"key":"bibr16-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199511000-00010"},{"key":"bibr17-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.3109\/ort.1980.51.suppl-184.01"},{"key":"bibr18-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1985.tb04520.x"},{"key":"bibr19-112070000901906s12","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199709000-00003"},{"key":"bibr20-112070000901906s12","first-page":"S13","volume":"13","author":"Aiona M.D.","year":"2004","journal-title":"J Pediatr Orthop B"},{"key":"bibr21-112070000901906s12","first-page":"279","volume":"88","author":"Deleplanque B.","year":"2002","journal-title":"Rev Clin Orthop Reparatrice appar Mot"},{"key":"bibr22-112070000901906s12","first-page":"105","volume-title":"Management of the motor disorders of children with cerebral palsy.","author":"Graham H.K.","year":"2004","edition":"2"}],"container-title":["HIP International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/112070000901906s12","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/112070000901906s12","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:19:59Z","timestamp":1777450799000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/112070000901906s12"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,1]]},"references-count":22,"journal-issue":{"issue":"6_suppl","published-print":{"date-parts":[[2009,1]]}},"alternative-id":["10.1177\/112070000901906s12"],"URL":"https:\/\/doi.org\/10.1177\/112070000901906s12","relation":{},"ISSN":["1120-7000","1724-6067"],"issn-type":[{"value":"1120-7000","type":"print"},{"value":"1724-6067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,1]]}}}