Femoral derotation osteotomy in spastic diplegia

Pirpiris, Marinis; Trivett, Adrian; Baker, Richard; Rodda, Jill; Nattrass, Gary; Graham, H. Kerr

doi:10.1302/0301-620x.85b2.13342

Cited by 123 publications

(119 citation statements)

References 49 publications

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“…This, however, could be important information when planning a derotational osteotomy. Currently, debate still surrounds the ideal site for an osteotomy, which can be performed proximally or distally [4,8,9,21,22]. If an osteotomy is performed at the site of the deformity, normal anatomy can be restored [6].…”

Section: Discussionmentioning

confidence: 99%

“…While the treatment of deformities in frontal or sagittal plane is based on well-established rules drawing on the concept of the centre of rotation of angulation (CORA) [6,7], there are no specific treatment rules for femoral torsional deformities. Hence, disagreement still prevails on whether an osteotomy should be performed proximally or distally in patients with pathologic femoral torsion [8,9]. Knowing the segment of the femur in which a torsional deformity is actually localized (i.e., concept of CORA) could help us in this discussion and eventually improve treatment guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Ferlic

Runer

Seeber

et al. 2017

International Orthopaedics (SICOT)

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Purpose De-rotational osteotomies are indicated in patients with pathologic femoral torsion. However, there is disagreement whether an osteotomy should be performed proximally or distally. Conventionally only the total torsion is measured, which does not allow differentiation between a torsional deformity located in the proximal or distal metaphysis or the diaphysis. The aim of this study is to validate a new multilevel measurement protocol for evaluation of the magnitude of torsion of the respective femoral segments in CT. Patients and methods The torsional profile of 30 femora was evaluated in CT scans. For separate measurements of the torsion of the metaphysis and the diaphysis, four axes where determined: one through the femoral neck, a second determined by the midpoint of the femoral shaft and the lesser trochanter, a third determined by a tangent dorsal to the popliteal surface, and a fourth axis posterior to the condyles. The total femoral torsion was measured between the first and the fourth axis, proximal torsion between the first and the second, mid torsion between the second and the third, and distal torsion between the third and the fourth axis. Four investigators performed all measurements independently and intraclass correlation coefficients (ICC) were calculated to evaluate intra-and inter-rater reliability. Results Average total femoral torsion was 22.6 ± 8.7°, proximal torsion 47.7 ± 10.6°, mid torsion −33.4 ± 9.9°, and distal torsion 8.3 ± 3.2°. Intra-rater ICC ranged between 0.504 and 0.957 and inter-rater ICC between 0.643 and 0.992. The majority of the ICC were graded as Balmost perfect^and some as Bsubstantial^agreement. Conclusion Evaluation of the segmental torsion of the femur allows in-depth analysis of femoral alignment. High reliability was shown for this measuring method in computed tomography, which can be deployed when studying interdependencies between joint pathologies and torsional deformities or when planning the site for an osteotomy. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Ferlic

Runer

Seeber

et al. 2017

International Orthopaedics (SICOT)

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“…If the hips are stable, distal femoral osteotomy is an equally effective procedure, which offers some advantages over proximal femoral osteotomy. 65 In either case, precise correction, stable fixation and early mobilisation are essential to a good outcome. Supramalleolar osteotomy of the tibia and fibula is the best technique for correction of lateral tibial torsion.…”

Section: Figmentioning

confidence: 99%

Musculoskeletal Aspects of Cerebral Palsy

Graham

Selber

2003

The Journal of Bone and Joint Surgery. British volume

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355

331

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“…a minimum of four procedures). 4 To determine the effects of major interventions such as SEMLS, there is a need for tools that can accurately measure change over time in activities such as mobility. The FMS quantifies functional mobility, which is a key aspect of the activity and participation domains of the International Classification of Functioning, Disability and Health.…”

mentioning

confidence: 99%

The Functional Mobility Scale: ability to detect change following single event multilevel surgery

Harvey¹,

Graham

Morris

et al. 2007

Develop Med Child Neuro

107

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The aim of this study was to examine the ability of the Functional Mobility Scale (FMS) to detect change in children with cerebral palsy (CP) undergoing single event multilevel surgery (SEMLS). A retrospective study was conducted of gait laboratory records and video assessments for a consecutive sample of children with CP aged 4 to 18 years who were managed by multilevel surgery. FMS ratings and Gross Motor Function Classification System (GMFCS) levels were recorded preoperatively and at regular postoperative time points. The sample comprised 66 children (32 females, 34 males) with spastic diplegia, GMFCS Levels I (n=18), II (n=24), and III (n=24). The mean age at surgery was 10 years (SD 2y 6mo, range 6-16y). For each FMS distance (5, 50, and 500m) odds ratios showed significant deterioration in mobility at 3 and 6 months postoperatively. Mobility then improved to baseline levels by 12 months and improved further by 24 months postoperatively. GMFCS level remained stable throughout most of the postoperative period for children classified as GMFCS Level III preoperatively but not for children classified as Levels I or II. The FMS was found to be a clinically feasible tool for quantifying change after SEMLS in children with CP.This investigation examines the ability of the Functional Mobility Scale (FMS) to detect change following single event multilevel surgery (SEMLS) in children with cerebral palsy (CP). The FMS is an evaluative measure of functional mobility in children with CP aged 4 to 18 years. Although the FMS is used in clinical practice and initial testing has been conducted, 1 further validation is required because not all aspects of validity were adequately explored in the previous study.For children with CP, the correction of musculoskeletal deformities producing gait deviations is usually performed in one session. 2 SEMLS refers to the correction of all orthopaedic deformities in one session 3 and can be defined as at least two orthopaedic procedures at different anatomical sites in each limb (i.e. a minimum of four procedures). 4 To determine the effects of major interventions such as SEMLS, there is a need for tools that can accurately measure change over time in activities such as mobility. The FMS quantifies functional mobility, which is a key aspect of the activity and participation domains of the International Classification of Functioning, Disability and Health. 5 Using this classification, activity is conceptualized as 'the execution of a task or action by an individual' and participation is 'the involvement in life situations'. Functional mobility enables children with CP to move around within the home, school, and community environments to allow participation in the family setting and society.A unique feature of the FMS is the ability to distinguish between different assistive devices used by the children at home, school, and in the wider community. Assistive devices range from walkers and crutches to wheelchairs. The FMS measures performance, which is what the child 'does do' in the usual ...

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Femoral derotation osteotomy in spastic diplegia

Cited by 123 publications

References 49 publications

Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Musculoskeletal Aspects of Cerebral Palsy

The Functional Mobility Scale: ability to detect change following single event multilevel surgery

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