ABSTRACT
PURPOSE: This review presents an overview of the effectiveness of preventive and corrective surgical interventions to treat hip displacement in patients with severe cerebral palsy (CP). METHOD: A systematic literature search was applied to identify studies concerning surgical procedures in hip(sub)luxations in severe CP (GMFCS IV and V). A qualitative analysis and a best evidence synthesis were performed for soft tissue surgery and osteotomies. RESULTS: The literature search identified 15 studies, all of which were observational. Five studies involved soft tissue surgery and 10 involved osteotomies. Only one study involving soft tissue surgery was of sufficient quality. Nine of the 10 studies involving osteotomies were of sufficient quality, including a total of 189 patients. The mean MP (migration percentage) at follow-up ranged from 6 to 29%. No relationship could be established between the effect of the surgical procedure and the patients' age or the duration of follow-up. The percentage of patients reporting pain decreased from 81% preoperatively to 5% at follow-up. Twenty-five percent had complications such as osteoarthritis, ulcers or fractures. CONCLUSIONS: There is insufficient evidence for the effectiveness of soft tissue surgery to stabilize the hip, due to insufficient quality of the retrospective observational studies. This review shows indicative findings (provided by consistent, statistically significant findings on outcome and/or process measures in at least two Observational Studies with sufficient quality) for an effect of bony surgery in stabilizing the hip. Timing of the procedure remains an issue. Multicenter trials could shed further light on this complicated subject.
Subject(s)
Cerebral Palsy/complications , Cerebral Palsy/rehabilitation , Hip Dislocation/prevention & control , Hip Dislocation/surgery , Osteotomy/statistics & numerical data , Humans , Observational Studies as Topic , Postoperative Complications , Treatment OutcomeABSTRACT
We performed a systematic review of the results of palliative hip surgery in severe cerebral palsy. Individuals with severe cerebral palsy frequently suffer from pain and other impairments because of dislocation or malformation of the hips. When preventive or reconstructive surgery fails, palliative intervention is performed. A number of salvage interventions have been described. We found articles on resection surgery of the femoral head, arthrodesis of the hip joint, and total hip replacement. The published literature does not clearly favor one procedure over the others. The resection arthroplasty technique developed by Castle is reported to yield the best results and fewer complications, and seems to eventually lead to a good outcome.
Subject(s)
Cerebral Palsy/surgery , Hip Joint/surgery , Palliative Care/methods , Adolescent , Arthrodesis/adverse effects , Arthrodesis/methods , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Cerebral Palsy/diagnosis , Child , Child, Preschool , Female , Hip Joint/physiopathology , Humans , Male , Osteotomy/adverse effects , Osteotomy/methods , Prognosis , Risk Assessment , Severity of Illness Index , Treatment Outcome , Young AdultABSTRACT
The Gollop-Wolfgang Complex is a very rare anomaly, which has its essential features in congenital absence of the tibia and ipsilateral bifurcation of the femur. Surgical treatment of two patients with a follow-up of 5 years is reported.
Subject(s)
Abnormalities, Multiple/pathology , Amputation, Surgical , Femur/abnormalities , Limb Deformities, Congenital/pathology , Tibia/abnormalities , Abnormalities, Multiple/surgery , Child, Preschool , Femur/surgery , Follow-Up Studies , Humans , Infant, Newborn , Limb Deformities, Congenital/surgery , Male , Syndrome , Tibia/surgeryABSTRACT
We performed a cross-sectional study of 160 adult patients with severe cerebral palsy to study the relationship between radiographic hip disorders (migration and deformity of the femoral head), on the one hand, and complications such as handling problems, seating problems, decubitus ulcers, fractures and contractures, on the other hand. Both migration and deformity were positively related to the need for a special seat in the wheelchair and adduction contractures of the hip. We conclude that migration and deformity of the femoral head, if possible, should be prevented in patients with severe cerebral palsy.
Subject(s)
Cerebral Palsy/complications , Hip Joint , Adult , Cross-Sectional Studies , Female , Femur Head , Humans , Joint Diseases/diagnostic imaging , Joint Diseases/etiology , Joint Diseases/prevention & control , Male , RadiographyABSTRACT
The purpose of our investigation was to study the relationship between radiographic results of the femoral head and pain in people with severe cerebral palsy. We conducted a cross-sectional study on hip radiography results and pain in 160 patients with severe cerebral palsy. Eighteen percent of our patients had hip pain in hip-loading situations. Migration and deformity were closely related. There was a significant association with hip pain (odds ratio, 2.79; 95% confidence interval 1.01-7.70). There is a high prevalence of hip pain after unsuccessful femoral bone surgery. Migration and deformity of the femoral head are strongly interrelated, and are associated with pain.
Subject(s)
Arthralgia/diagnostic imaging , Cerebral Palsy/complications , Femur Head/diagnostic imaging , Hip Dislocation/diagnostic imaging , Range of Motion, Articular/physiology , Adult , Arthralgia/epidemiology , Arthralgia/etiology , Cerebral Palsy/diagnosis , Cross-Sectional Studies , Female , Femur Head/physiopathology , Follow-Up Studies , Hip Dislocation/epidemiology , Hip Dislocation/etiology , Hip Dislocation/surgery , Hip Joint , Humans , Male , Muscle Spasticity/etiology , Muscle Spasticity/physiopathology , Odds Ratio , Pain Measurement , Prevalence , Probability , Radiography , Risk Factors , Severity of Illness IndexABSTRACT
A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphysis in a 17-year-old boy is described. This type of fracture, which can be associated with intra-articular lesions and lesions of the extensor mechanism, resembles the better known distal tibial triplane fracture. Arthroscopic controlled anatomic reduction with restoration of the articular surface was achieved.
Subject(s)
Epiphyses/injuries , Tibial Fractures/diagnosis , Adolescent , Arthroscopy , Epiphyses/surgery , Humans , Knee Joint/surgery , Male , Soccer/injuries , Tibial Fractures/surgeryABSTRACT
Hip fracture in patients with open physis is known for its low occurrence rate. However, despite its rare presentation, this type of fracture is known for its serious complications. Avascular necrosis (AVN), coxa vara, premature closure of the physis and secondary displacement are major complications that will determine prognosis. AVN with associated growth disturbances is the most serious complication and also an influential factor in predicting the outcome. This paper reports a retrospective study of 20 children who sustained a hip fracture according to Delbet type I-IV followed for at least 2 years. AVN was observed in four patients (21%), two of whom developed a complete AVN Ratliff type I within 6 months, requiring reconstructive surgery. Non-AVN-associated coxa vara (n=5) and re-displacement (n=3) are complications with less serious effects on outcome. Our clinical results regarding AVN and its risk factors - such as age group and type of fracture - are comparable to the results of other documented reports. An overview of both avoidable and inevitable AVN risk factors, including possible preventative measures, is presented in this report.
