Internal rotation gait in spastic diplegia—Critical considerations for the femoral derotation osteotomy

Dreher, Thomas; Wolf, Sebastian I.; Braatz, Frank; Patikas, Dimitrios; Döderlein, Leonhard

doi:10.1016/j.gaitpost.2006.07.018

Cited by 83 publications

(88 citation statements)

References 30 publications

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“…The extent of derotation was determined by the midpoint of rotation on clinical examination [23]. The derotation angle was monitored intraoperatively by two K-wires inserted proximally and distally at the osteotomy site [2]. Directly before plate fixation, three conditions were checked: (a) clinical midpoint in neutral position, (b) at least 20°of passive internal rotation remaining, and (c) the legs assuming external rotation position spontaneously.…”

Section: Methodsmentioning

confidence: 99%

“…There is agreement that both methods provide comparable static and functional results but that distal osteotomy is less complicated [4,16,18]. However, recent studies have shown a high rate of over-and undercorrection [2] and recurrence [19][20][21] of IRG following FDO in contrast to previous studies [4].…”

Section: Introductionmentioning

confidence: 93%

“…The pathogenesis of IRG is complex and not fully understood [2,3]. Patients with this condition often subsequently develop functional and cosmetic gait disturbances [4] which are frequently accompanied by an increase in the internal foot progression angle.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast to the physiological development in healthy children, in whom femoral anteversion decreases over time, it often does not decrease in patients with CP [3,[8][9][10][11]. However, not all ambulatory children with CP and IRG present with an increase in femoral anteversion and it is therefore obvious that dynamic factors need to be considered [2,8,12,13]. Muscular imbalance, crouch gait, and spasticity of the hip internal rotators may also contribute to IRG [14].…”

Section: Introductionmentioning

confidence: 99%

“…In the treatment of IRG, the static factor (increased femoral anteversion) is mainly managed by performing femoral derotation osteotomy (FDO), which is commonly applied to correct IRG [2,4]. It can be carried out at the inter-trochanteric level (proximal FDO) or at the supracondylar level (distal FDO) [16,17].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Braatz

Wolf

Gerber

et al. 2013

International Orthopaedics (SICOT)

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Purpose Femoral derotation osteotomy (FDO) is commonly used to correct internal rotation gait (IRG) in spastic diplegia. The purpose of this study was to investigate whether the extent of intraoperative derotation is reflected in changes in static (clinical ROM and anteversion angle measured on torsional MRI) and dynamic parameters (transverse plane kinematics in three-dimensional gait analysis) after FDO in children with spastic diplegia. Methods In a prospective study, 30 children with spastic diplegia and IRG were treated with FDO as part of a multilevel surgery and were examined pre-and postoperatively clinically, by three-dimensional gait analysis and by torsional MRI according to a standardised protocol. Results A correlation (r=0.317, p=0.015) between the extent of intraoperative derotation and mean hip rotation in stance as well as the anteversion angle measured on torsional MRI (r=0.454, p<0.001) was found. However, no significant correlation was observed between anteversion angle (tMRI) and mean hip rotation in stance, either before or after FDO. Conclusions Significant improvements were found in IRG after FDO, confirming the results of previous studies. There was no correlation between the anteversion measured on MRI and the mean hip rotation in stance in 3D gait analysis before or after FDO. Thus, the data suggest that if the intraoperative extent of derotation is determined only by the anteversion angle, the result will not be better after FDO. It might only help to avoid retroversion and indicate the maximum amount of femoral derotation. In this study the extent of the intraoperative derotation was orientated at the preoperative midpoint of rotation. Based on the small, but significant correlation between the clinical midpoint and the mean hip rotation in stance in the gait analysis, determination of the intraoperative extent of derotation according to the mean hip rotation in stance seems to give the best results.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Braatz

Wolf

Gerber

et al. 2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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Electromagnetic bone segment tracking to control femoral derotation osteotomy-A saw bone study

et al. 2016

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Correction of rotational gait abnormalities is common practice in pediatric orthopaedics such as in children with cerebral palsy. Femoral derotation osteotomy is established as a standard treatment, however, different authors reported substantial variability in outcomes following surgery with patients showing over- or under-correction. Only 60% of the applied correction is observed postoperatively, which strongly suggests intraoperative measurement error or loss of correction during surgery. This study was conducted to verify the impact of error sources in the derotation procedure and assess the utility of a newly developed, instrumented measurement system based on electromagnetic tracking aiming to improve the accuracy of rotational correction. A supracondylar derotation osteotomy was performed in 21 artificial femur sawbones and the amount of derotation was quantified during the procedure by the tracking system and by nine raters using a conventional goniometer. Accuracy of both measurement devices was determined by repeated computer tomography scans. Average derotation measured by the tracking system differed by 0.1° ± 1.6° from the defined reference measurement . In contrast, a high inter-rater variability was found in goniometric measurements (range: 10.8° ± 6.9°, mean interquartile distance: 6.6°). During fixation of the osteosynthesis, the tracking system reliably detected unintentional manipulation of the correction angle with a mean absolute change of 4.0° ± 3.2°. Our findings show that conventional control of femoral derotation is subject to relevant observer bias whereas instrumental tracking yields accuracy better than ±2°. The tracking system is a step towards more reliable and safe implementation of femoral correction, promising substantial improvements of patient safety in the future. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1106-1112, 2017.

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Electromagnetic tracking for femoral derotation osteotomy—an in vivo study

Geisbüsch

Auer

Dickhaus

et al. 2017

Journal Orthopaedic Research

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Femoral derotation osteotomy delivers good to excellent results in the treatment of rotational gait abnormalities and especially in internal rotation gait. The outcome of the procedure has been evaluated in numerous short- and long-term studies. Although reasons for recurrence and over-/under-correction have been unveiled in earlier studies the mechanisms are still not fully understood. False intra-operative assessment of the derotation angle may contribute to imprecise outcomes. In a recent saw-bone study we evaluated an electromagnetic tracking system in comparison to conventional goniometer measurement and a CT reference measurement and found it to be extremely accurate, whereas the use of a conventional goniometer for derotation measurement showed a high inter- and intra-rater variability. The current study evaluates the electromagnetic tracking system for continuous intra-operative derotation control under real OR conditions. Adults (age: 18-40 years) with the diagnosis of internal rotation gait, independent of the underling pathology, undergoing a supracondylar deroation osteotomy were included. A rotational CT scan was conducted before and in close proximity after surgery and the difference served as reference for the electromagnetic tracking results. The results showed a mean deviation of 2.6° (1.2-5.5°) in comparison to the reference measurement of the pre- and post-operative CT scans. The system proved to be stable under OR conditions with a good usability and a small technical footprint. Electromagnetic tracking delivers a precise, reliable, and independent assessment of intra-operative derotation angles in femoral derotation osteotomies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2652-2657, 2017.

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Internal rotation gait in spastic diplegia—Critical considerations for the femoral derotation osteotomy

Cited by 83 publications

References 30 publications

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Electromagnetic bone segment tracking to control femoral derotation osteotomy-A saw bone study

Electromagnetic tracking for femoral derotation osteotomy—an in vivo study

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