Derotational Subtrochanteric Osteotomy of the Femur in Celebral Palsy Patients

Schejbalová, A

doi:10.55095/achot2006/048

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…Korekční osteotomie proximálního femuru u dětí jsou stále často užívaným výkonem v terapii širokého spektra vad a onemocnění této části dětského skeletu. Na straně jedné díky včasné novorozenecké diagnostice ubylo případů vývojového vykloubení kyčelních kloubů a s tím souvisejících avaskulárních nekróz hlavice femuru a jejich následků (4, 5, 7, 18, 22,23,25), na straně druhé se dnes častěji operuje M. Calvé-Legg-Perthes (8) stejně jako instability kyčelního kloubu u dětské mozkové obrny (19,20), coxa vara adolescentium (10), zlomeniny proximálního femuru nebo stavy po nich. Vedle mnoho let používaných a osvědčených úhlových dlah ať již klasických (2, 3) nebo inovovaných jako "Cannulated Pediatric Osteotomy System -CAPOS" (24) se v rámci všeobecného rozvoje zamykatelných dlah (LCP-Locked Compression Plate) objevily i implantáty s tímto principem pro fixaci fraktury nebo osteotomie proximálního femuru v dětském a adolescentním věku.…”

Section: úVodunclassified

Accuracy of Proximal Femur Correction Achieved with LCP Paediatric Hip Plates

Ročák¹,

Poul²,

Urbášek³

2013

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYThe aim of the study was to evaluate, in comparison with the pre-operative planning, the accuracy of proximal femur correction achieved with the use of locking compression paediatric hip plates (LCP) in children and adolescents and to assess pre-and post-operative complications. MATERIAL AnD METHODSA group of 52 patients in whom proximal femoral osteotomy using the LCP was performed on a total of 55 hips between September 2009 and February 2013 were retrospectively evaluated. The following diagnoses were treated: unstable hip in cerebral palsy, 18 operations; Legg-Calvé-Perthes disease, 10 operations; coxa vara of aetiology other than coxa vara adolescentium (CvA), eight operations; true CvA, six operations; femoral shortening by the Wagner method, six procedures; proximal femoral derotation osteotomy, four procedures; and post-traumatic pseudoarthrosis of the proximal femur, three operations. RESULTSCompared with the pre-operative plan, the average deviation of the colodiaphyseal angle was 5.2° (1° to 11°) in 18 unstable hips; 4.7° (1° to 10°) in 10 cases of Legg-Calvé-Perthes disease; 4.5° (3° to 6°) in eight hips with coxa vara of aetiology other than CvA; 6.5° (2° to 13°) in six CvA hips; 4.5° (1° to 10°) in six cases of femoral shortening; 3.5° (1° to 5°) in four derotation osteotomies; and 3.7° (0° to 6°) in three corrections of pseudoarthrosis. In one patient, osteosynthesis failed due to screws being pulled out from the proximal fragment; re-osteosynthesis was carried out using a conventional angled blade plate. DISCUSSIOnAs in other international studies, our results confirmed a high accuracy of proximal femur correction with use of the LCP instrumentation. The reported higher time requirement for this technique seems to be related to the learning curve and, with more frequent use, will probably be comparable to the time needed for application of conventional hip angled plates. COnCLUSIOnSThe up-to-date LCP fixation system using the principle of angular stability for correction of the proximal femur in children is a clear advancement and its higher costs are certain to be outweighed by its higher accuracy and thus better results.

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Section: úVodunclassified

Accuracy of Proximal Femur Correction Achieved with LCP Paediatric Hip Plates

Ročák¹,

Poul²,

Urbášek³

2013

Acta Chir. orthop. Traum. Cech.

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“…Nejčastěji se jedná o prodloužení flexorů kyčle, tenotomii adduktorů, prodloužení flexorů kolen a Achillových šlach. V indikovaných případech předchází i řešení dysplazií či luxací kyčelních kloubů (15,16,17).…”

Section: Windblown Hip Syndrom (Syndrom Vlající Kyčle)unclassified

Neuromuscular Deformity of the Pelvis and Its Surgical Treatment

Repko¹,

Krbec²,

Chaloupka³

et al. 2008

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYTo evaluate the efficacy of surgical treatment in pelvic deformities associated with neuromuscular spine deformity, using radiographic parameters and clinical outcome analysis. In the lumbo-pelvic region, spinal deformity is most frequently combined with pelvic obliquity, lumbar hyperlordosis, hip deformity and leg-length discrepancy. Pelvic deformities include an excessive posterior or anterior pelvic tilt, obliquity or rotation and windblown hip syndrome. MATERIAL AND METHODSIn the period from 1994 to 2006, 42 paediatric patients (28 girls and 14 boys) underwent surgical correction of spine and pelvic deformities by the Luque-Galveston technique. The group included 25 patients with an underlying diagnosis of a spastic form of cerebral palsy, seven patients affected by paralysis, six with Duchenne muscular dystrophy and four with spinal muscular atrophy. The average age at the time of surgery was 14 years and 3 months and the patients were followed-up for 7 years and 5 months on the average. The results were evaluated on the basis of findings on antero-posterior and lateral radiographs including the pelvis, hip joints and the whole spine. The patients were examined before surgery, then immediately after it, and at yearly follow-up intervals. RESULTSThe mean pre-operative pelvic obliquity was 37°(+/-6.0) and it improved to 9° (+/-4.5) post-operatively. Horizontalization of the sacrum was corrected from the mean preoperative value of 19° (+/-5.0) to 37° (+/-6.1) post operatively. This difference was statistically significant (p=0.001). Scoliosis curve correction achieved by the surgery was from 79° (+/-21.3) pre-operatively to 35° (+/-14.5) post-operatively, with a mean correction rate of 56 %. The following complications were recorded: faulty insertion of the pelvic fixation resulting in perforation of the medial cortical substance of the iliac crest in one patient, pseudoarthrosis in the region of thoraco-lumbal junction in two patients, instrumentation failure with the need of pseudoarthrosis resection and re-instrumentation in one patient, and deep infection requiring wound irrigation and longterm antibiotic therapy. DISCUSIONThe surgical correction of pelvic deformity is always associated with operative treatment of scoliosis. However, the procedure is regularly preceded by surgical correction of muscular imbalance of the lower limbs and pelvis and of hip deformities. The surgical stabilization of spinal and pelvic deformities brings about the loss of some alternative motor stereotypes. This disadvantage is compensated for by a better sitting stability and better prospects for prosthetic care. CONCLUSIONSThe radiographic and clinical findings in the patients treated showed good correction of pelvic deformities in the frontal and sagittal planes. Pelvic obliquity correction thus contributes to the improvement of sitting stability in physically disabled patients.

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Effects of Surgery on Muscles on Clinical and Radiographic Findings in the Hip Joint Region in Cerebral Palsy Patients

Schejbalová¹,

Havlas²

2008

Acta Chir. orthop. Traum. Cech.

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Derotational Subtrochanteric Osteotomy of the Femur in Celebral Palsy Patients

Cited by 4 publications

References 21 publications

Accuracy of Proximal Femur Correction Achieved with LCP Paediatric Hip Plates

Accuracy of Proximal Femur Correction Achieved with LCP Paediatric Hip Plates

Neuromuscular Deformity of the Pelvis and Its Surgical Treatment

Effects of Surgery on Muscles on Clinical and Radiographic Findings in the Hip Joint Region in Cerebral Palsy Patients

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