A Comparison of Hip Spica Casting to Short Leg Casts and Bar after Hip Reconstruction in Cerebral Palsy

Truong, Uyen; Sylvanus, Tonye; Koester, Trever M.; Barney, Chantel C.; Georgiadis, Andrew; Carpenter, Jennifer; Truong, Walter H.; Novotny, Susan A.

doi:10.7759/cureus.8028

Cited by 3 publications

(8 citation statements)

References 28 publications

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“…Recently, Truong et al compared spica casting to short-leg Petrie casting in patients with CP following hip reconstruction [ 16 ]. They found no difference in hip stability, narcotic pain medication usage, or complication profile.…”

Section: Discussionmentioning

confidence: 99%

“…They noted that it may be more important to use a spica cast for children with osteopenic bone at risk for implant failure, which is more common in non-ambulatory children. Truong et al suggested that there was no significant advantage in hip stabilization when comparing use of spica versus Petrie immobilization, but that more children who received spica casting experienced femoral fragility fractures [ 16 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Given the known complications of spica cast treatment, determining the safety profile of less restrictive methods of postoperative immobilization is important [ 16 , 20 ]. Our data suggest no significant differences in complication rates among the three methods of immobilization.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy

Tabaie¹,

Sadur²,

Shah³

2022

Cureus

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Objectives Currently, there is no standardized protocol for postoperative immobilization techniques in patients with cerebral palsy undergoing hip reconstructive procedures. The purpose of this study was to evaluate the effects of several methods of postoperative immobilization and to determine which postoperative immobilization technique has the fewest complications. Materials and methods A retrospective cohort study of pediatric patients with cerebral palsy who underwent hip reconstructive procedures, in which a hip spica cast, Petrie cast, or abduction pillow was placed for postoperative hip immobilization, was conducted. Patients who underwent revision surgery and those without cerebral palsy were excluded from the analysis. The final cohort consisted of 70 cases. Demographics, laterality of surgery, procedure type, hip immobilization technique, and 30-day postoperative complications were recorded. Complications were defined as those related to casting immobilization, such as re-dislocation or loss of surgical fixation, and soft tissue complications, such as pressure ulcers or any superficial or deep wound infection. Results Of the 70 patients, 27 received spica casting, 28 received Petrie casting, and 15 received an abduction pillow. The complication rates, as defined in the methods section, were 14.8% for the spica cast group, 17.9% for Petrie cast, and 26.7% for abduction pillow. There was no significant difference in complication rates among spica cast, Petrie cast, or abduction pillow groups (P=0.76). Conclusions There was no significant difference in length of stay, pain control duration, or complication rates among the three methods of immobilization. Clinicians should be advised of the comparable outcomes among the postoperative immobilization techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy

Tabaie¹,

Sadur²,

Shah³

2022

Cureus

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“…Albrektson et al compared the two methods in a retrospective review of 21 patients with CP or other genetic syndromes undergoing hip surgery and concluded that spica casts should be used in patients with osteopenia or instability in the early post-operative period ( 21 ). Truong et al demonstrated similar pain and complication profiles in children treated in spica casts versus short leg casts linked with a bar ( 27 ). Modern internal fixation has proven reliable in maintaining the alignment and compression of osteotomies during healing.…”

Section: Discussionmentioning

confidence: 98%

“…While hip spica casts were classically considered the standard for immobilization following hip reconstructive surgery in children with CP, there is evidence that satisfactory outcomes can be obtained with alternative methods of postoperative immobilization (19,24,25) (27). Modern internal fixation has proven reliable in maintaining the alignment and compression of osteotomies during healing.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Immobilization After Hip Reconstruction in Cerebral Palsy: No Difference Between Hip Spica and Abduction Pillow

et al. 2022

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PurposeThis study aims to compare radiographic outcomes and complication rates of immobilization with an abduction pillow to spica casting for postoperative care after a hip reconstruction with varus derotational proximal femur osteotomy (VDRO) with or without pelvic osteotomy for children with cerebral palsy (CP).Methods233 children (1–18 years old) diagnosed with CP that underwent VDRO with or without pelvic osteotomy were identified, of which 188 patients were immobilized with a spica cast and 45 were immobilized with an abduction pillow, based on surgeon preference. 123 (65%) in the Spica group and 21 (47%) in the pillow group had pelvic osteotomies. Demographic data and complication rates were collected. Radiographic parameters, including anatomic medial proximal femoral angle (aMPFA), acetabular index (AI) and migration percentage (MP), were measured for each patient at the completion of surgery, six weeks post-operatively, and one year post-operatively.ResultsThere was not a statistically significant difference in BMI (p = 0.285), gender distribution (p = 0.984), or median follow-up time (p = 0.314) between groups. Rates of complications were consistent among groups with no differences in instances of delayed unions (p = 0.10), subluxations (p = 0.55), infection (p = 0.71), or non-unions (p = 0.10). There was no statistically significant difference in number of patients with an ideal aMPFA, AI, or MP (p = 0.44, p = 0.19, p = 1.00) at one year post-operatively.ConclusionsImmobilization with an abduction pillow is a safe and effective alternative to hip spica casting following hip reconstruction.

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Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated?

Amen

Perkins

Kafchitsas³

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Decisions for postoperative immobilization after bony hip reconstructive surgery in cerebral palsy are controversial in current practice. The aim of this study was to check if choosing not to use any kind of postoperative immobilization is a safe practice. Methods: A retrospective cohort study was conducted in a pediatric orthopedic tertiary referral center. The study included 148 patients (228 hips) with cerebral palsy, who had bony hip surgery. Medical records were reviewed for incidence of complications, methods of pain control, and length of hospital stay. Three radiographic measures (neck-shaft angle, Reimers migration index, and acetabular index) were performed on preoperative and postoperative X-rays. X-rays were also checked for mechanical failure of implant, recurrent dislocation/subluxation, and fractures in the first 6 months postoperatively. Results: In total, 94 (64%) were male and 54 (36%) were female. Seventy-seven (52%) were Gross Motor Function Classification System V, mean age at surgery was 8.6 years (2.5–18.4 years). Length of hospital stay was 6.25 days (SD 4.64 days). Medical complications that may have prolonged hospital stay occurred in 41 patients (27.7%). Radiological measurements showed significant improvement postoperatively ( p = 0.001). Seven patients (4.7%) had another surgery in first 6 months (three for recurrent dislocation/subluxation, three for implant failure, and one for ipsilateral femur fracture). Conclusion: Avoiding postoperative immobilization following bony hip surgery in cerebral palsy is a safe practice and associated with reduced rate of medical and mechanical problems compared to the current literature. This approach should be utilized with optimal pain and tone management.

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A Comparison of Hip Spica Casting to Short Leg Casts and Bar after Hip Reconstruction in Cerebral Palsy

Abstract: Truong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 3 publications

References 28 publications

Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy

Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy

Postoperative Immobilization After Hip Reconstruction in Cerebral Palsy: No Difference Between Hip Spica and Abduction Pillow

Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated?

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