Risk Factors for Hip Displacement in Children With Cerebral Palsy: Systematic Review

Pruszczyński, Błażej; Sees, Julieanne P.; Miller, Freeman

doi:10.1097/bpo.0000000000000577

Cited by 60 publications

(54 citation statements)

References 18 publications

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“…No se incluyeron pacientes menores de 2 años dado que el diagnóstico de PC usualmente se realiza sobre esta edad (1) , y no se incluyeron pacientes mayores de 8 años debido a la baja probabilidad de desplazamiento de cadera que se presenta en esta edad (15) . No se incluyeron pacientes con GMFCS menor a III, dada la baja tasa de progresión en el desplazamiento de cadera que presentan estos pacientes (3) . Pacientes con PM >40% generalmente requieren cirugía ósea de entrada (16) , por lo que dada su alteración anatómica (especialmente ACD) resultante, se excluyeron pacientes en quienes se realizó cirugía ósea de pelvis o cadera, o ambas.…”

Section: Pacientes Y Métodounclassified

“…Se han establecido factores de riesgo para el desplazamiento de cadera. Según Pruszczynski y colaboradores (3) , los factores de riesgo a tener en cuenta son el nivel de GMFCS, a mayor nivel, mayor probabilidad de migración; la edad, registrándose un pico entre los 3 y 5 años; los desórdenes de tono muscular y movimiento, mayor en diplejía espástica y distonía, y tasa de aumento del desplazamiento de cadera, evaluada comúnmente por PM o índice de Reimers. Se considera un índice de Reimers <33% como normal, entre 33% y 40% como cadera en riesgo, > 40% como cadera subluxada y 100% cuando la cadera está luxada (4) .…”

Section: Introductionunclassified

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Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell

Rehbein

Teske

Heideken

2019

REVISTA MEDICA DEL URUGUAY

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Introducción: la luxación de cadera es una complicación severa en pacientes con parálisis cerebral (PC), sobre todo en pacientes incluidos en el sistema de clasificación de la función motora gruesa (GMFCS, por su sigla en inglés) III-V. Para su identificación son necesarias radiografías de pelvis. Objetivos: evaluar el seguimiento radiográfico en estos pacientes y la detección precoz de esta complicación en nuestro hospital. Material y método: se revisaron historias clínicas y radiografías de 17 pacientes GMFCS III-V, entre 2 y 8 años de edad al momento de la radiografía de pelvis índice, midiendo el porcentaje de migración (PM) de cadera de acuerdo al índice de Reimer, el ángulo cérvico-diafisiario y calculando el CPUP Score de cada cadera. Evaluamos el control radiográfico al año o posteriormente a esa fecha, y de no haber sido así, se citaría a los pacientes a control radiológico para detectar las caderas con riesgo migratorio elevado. Resultados: de los 17 pacientes evaluados, 3 (18%) tuvieron una nueva radiografía de pelvis al año; 6 (35%) pacientes la tuvieron posteriormente al año, y antes de la fecha de control designada, 7 (41%) pacientes nunca fueron controlados, citándose para nueva radiografía en 2018. Un paciente (6%) se perdió en el seguimiento. Un paciente presentó una cadera con riesgo alto (CPUP Score 50%-60%), el resto tuvo PM dentro de rangos normales. Conclusiones: pocos pacientes con PC GMFCS III-V tuvieron un seguimiento radiográfico anual. Los monitoreados posteriormente no mostraron progresión de esta condición. El resultado de este estudio y la literatura respaldan la introducción de un programa de vigilancia en nuestro hospital.

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Section: Pacientes Y Métodounclassified

Section: Introductionunclassified

Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell

Rehbein

Teske

Heideken

2019

REVISTA MEDICA DEL URUGUAY

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“…Based on a recent systematic review, screening is recommended with a single X-ray for GMFCS I and II, or, if RMI >30%, an annual X-ray between ages 2 and 8 years, followed by an X-ray every 2 years until the age of 18 years. For GMFCS III, IV, and V, an annual X-ray is recommended if RMI <30% or 1 every 6 months if RMI >30% between ages 2 and 8 years, followed by X-ray every 2 years until the age of 18 years 81. With the compelling evidence of the success of a hip surveillance programme,82 orthopedic surgeons must ensure that no child with CP develops a hip dislocation for lack of timely X-rays and early surgical intervention.…”

Section: Hip Surgerymentioning

confidence: 99%

Orthopedic surgery in cerebral palsy: Instructional course lecture

Sharan¹

2017

IJOO

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Orthopedic surgery (OS) plays an important role in the management of cerebral palsy (CP). The objectives of OS are to optimize functions and prevent deformity. Newer developments in OS for CP include emphasis on hip surveillance, minimally invasive procedures, use of external fixators instead of plates and screws, better understanding of lever arm dysfunctions (that can only be corrected by bony OS), orthopedic selective spasticity-control surgery, and single-event multilevel lever arm restoration and anti spasticity surgery, which have led to significant improvements in gross motor function and ambulation, especially in spastic quadriplegia, athetosis, and dystonia. The results of OS can be dramatic and life altering for the person with CP and their caregivers if it is performed meticulously by a specialized surgical team, at the appropriate age, for the correct indications, employing sound biomechanical principles and is followed by physician-led, protocol based, intensive, multidisciplinary, institutional rehabilitation, and long term followup. However, OS can be a double-edged sword, and if performed less than optimally, and without the supporting multidisciplinary medical and rehabilitation team, expertise and infrastructure, it often leads to significant functional worsening of the person with CP, including irretrievable loss of previous ambulatory capacity. OS must be integrated into the long term management of the person with CP and should be anticipated and planned at the optimal time and not viewed as a “last resort” intervention or failure of rehabilitation. This instructional course lecture reviews the relevant contemporary principles and techniques of OS in CP.

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“…1 CP is one of the most common causes of physical disability in children, accounting for 2% to 2.5% per 1000 live births. 2 There are two major subtypes of CP: the spastic form and the non-spastic form which can be further divided as the dyskinetic and ataxic types. 3 Spastic form of CP is highly predominant in preterm infants and remains the leading type in term infants as well.…”

Section: Introductionmentioning

confidence: 99%

Lower extremity soft tissue surgery in spastic cerebral palsy: experience from a government rehabilitation unit

2018

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Background: Spastic cerebral palsy (CP) remains the most common type of CP and may be managed surgically or non-surgically depending upon its severity. Recent advances have replaced single-level surgery by the concept of multilevel surgery where multiple levels of musculoskeletal pathology, in one/both lower limbs, are addressed during one operative procedure, requiring only one hospital admission and one period of rehabilitation. This study assessed the outcome of lower limb soft tissue surgery in children with spastic CP in a government rehabilitation unit and measured its feasibility with limited infrastructure facilities and patient compliance.Methods: The study comprised of 26 patients aged between 2-12 years. Physical examination and GMFCS scores were recorded and evaluation of sitting balance, standing balance and gait were done. Musculotendinous soft tissue lower limb surgery was performed at one or more levels unilaterally or bilaterally and the results were interpreted.Results: Complete or near complete correction of deformities were attained by all children postoperatively. Significant improvements were noted in the gross motor functional classification system (GMFCS) scores. All parents and children were satisfied with the surgical outcome and reported improvement in functional abilities and locomotion in the follow-up along with better quality of life and mobility. Conclusions: Lower limb soft tissue surgery is a valuable aid in improving functional abilities and locomotion in children with spastic CP. Surgery should be undertaken depending upon clinical indications and can be successfully carried out in government hospitals with ordinary infrastructure in developing countries as well.

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Risk Factors for Hip Displacement in Children With Cerebral Palsy: Systematic Review

Abstract: Level III-systematic review.

Cited by 60 publications

References 18 publications

Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell

Evaluación del seguimiento radiográfico para desplazamiento de cadera en pacientes con parálisis cerebral en el Centro Hospitalario Pereira Rossell

Orthopedic surgery in cerebral palsy: Instructional course lecture

Lower extremity soft tissue surgery in spastic cerebral palsy: experience from a government rehabilitation unit

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