Derotational Subtrochanteric Osteotomy and External Fixation for the Treatment of Neurogenic Hip Dislocation in Children with Cerebral Palsy: Could This Be a Viable Method of Treatment?

Abstract

The treatment of painful and chronic dislocated hip in children with severe cerebral palsy (CP) is particularly demanding and controversial. Numerous surgical techniques have been described, and their outcomes vary a lot. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy (VDSO) and external osteosynthesis: (VDSOEO). Methods Six non-ambulatory children with spastic quadriplegia and chronic dislocated painful hips were treated. The technique involved a small incision on the subtrochanteric site of the osteotomy, followed by retention with a single-sided external osteosynthesis with rotational correction capability [swiveling clamp (SC)] for the reduction of the femur head in the acetabulum, and finally by the osteotomy. Hardware was removed without a second intervention four-six months postoperatively and after the osteotomy was healed. Evaluation of the method was based on clinical, functional, and radiological criteria. Results Four patients achieved improved radiological scores. Two patients demonstrated resubluxation during the period of the osteotomy's healing process. However, no patients experienced pain, and all were able to sit post-surgery, while caregivers reported improved capacity for nursing care.

Serebral palsi tedavisinde ortopedik cerrahide yenilikler: Alt ekstremite

“…amacıyla aynı seansta yumuşak doku ve kemik ameliyatları ile restorasyonu sağlamak ve en kısa zamanda cerrahiye özel, erken dönemde pasif ve geç dönemde aktif rehabilitasyon programı uygulamak güncel yaklaşımdır (Tablo 3). [3,11,21,22,[25][26][27][28][29] Büyük çaba ile karmaşık cerrahi yapıldığında, her zaman SP'li hastaların büyük kazançlar elde edeceği düşünülmemelidir. [11,16,28,29]…”