Early Bony Hip Reconstructive Surgery for Hip Subluxation in Children With Severe Cerebral Palsy.

Hip subluxation occurs frequently in children with severe cerebral palsy. This retrospective study examined the effects of age and type of bony surgery on radiographic outcomes of children with severe cerebral palsy who were treated for hip subluxation. The study included nonambulatory children with cerebral palsy undergoing bony hip reconstructive surgery consisting of proximal femoral varus derotational osteotomy (VDRO) alone or combined with pelvic osteotomy. The migration index was recorded for preoperative, postoperative, and final follow-up (minimum 2 years) radiographs. Failure was defined as subsequent bony hip reconstructive surgery or final follow-up migration index greater than 50%. Seventy-seven hips in 40 patients younger than 6 years (55 VDRO alone, 22 combined) and 73 hips in 43 patients older than 6 years (27 VDRO alone, 46 combined) met inclusion criteria. For VDRO alone, the failure rate for patients younger than 6 years (33%) was significantly higher than for patients older than 6 years (7%). For combined procedures, failure rates between younger (0%) and older groups (9%) were not significantly different. Patients younger than 6 years undergoing combined procedures started with a significantly worse migration index than patients undergoing VDRO alone, 72% vs 46%, yet had significantly better final migration indices of 13% vs 31%, respectively. For surgeons performing bony reconstructive surgery to treat hip subluxation in younger children with severe cerebral palsy who are nonambulatory, the findings of this study support the use of combined VDRO and pelvic osteotomy. [Orthopedics. 2021;44(2):e294-e300.].

Pectoralis Major Tendon Insertion Anatomy and Description of a Novel Anatomic Reference.

Pectoralis major rupture is an uncommon injury often treated surgically, requiring anatomic knowledge of the tendon insertion. This study defines the pectoralis major tendon insertion footprint and a novel anatomic relationship. Twelve cadaver shoulders were evaluated andmeasured using a standard surgical ruler to demonstrate the normal anatomic footprint. Measurements were taken from the anterior medial margin of the articular surface of the humeral head to the superior margin of the pectoralis major insertion and its relation to the latissimus dorsi tendon insertion. The average length and width of the pectoralis major insertion were 73.3 ± 10.0 mm and 3.3 ± 0.54 mm, respectively, consistent with previous publications. On average, the superior margin of the pectoralis tendon was within 1 mm of the latissimus dorsi insertion and 41.2 ± 9.27 mm from the articular margin. These points form a new anatomic reference of the latissimus dorsi, providing an intraoperative reference point when performing pectoralis major muscle tendon repair. (Journal of Surgical Orthopaedic Advances 27(1):39-41, 2018).