Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy.

Palliative Schanz proximal femoral valgus osteotomy is considered a common option for treatment of irreducible hip dislocation in cerebral palsy. From 1992 to 2005, Schanz osteotomy was indicated on 55 occasions in 35 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9-18. Postoperatively, the main emphasis focussed on clinical presentation, improvement of hip range of motion, and pain relief. X-rays were carried out at three, six, and 12 months postoperatively with subsequent average follow up 98 +/- 4.5 months. In all patients, the range of hip abduction and flexion increased. In 54 (98.2%) cases painful symptoms significantly improved. One patient (1.8%) had a subsequent femoral head excision because of persistent hip pain. Transient hip pain persisted in four patients (7.3%). Schanz valgus osteotomy improves the hip range of motion, relieves pain, and facilitates care of the patient. Schanz femoral osteotomy is a less invasive method compared to proximal femoral excision and should preferably be used in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.

Manipulation of pediatric supracondylar fractures of humerus in prone position under general anesthesia.

BACKGROUND: Displaced pediatric supracondylar fractures are usually treated with manipulation and fixation with Kirschner wires. The procedure is commonly performed with the patient in supine position. Reducing and stabilizing the fracture with the patient in supine position are associated with various risks and technical difficulties. METHODS: We describe a technique of manipulative reduction and fixation of pediatric supracondylar fractures by positioning the patient prone. RESULTS: We have used this technique in 455 patients and prefer it to the commonly described method of fracture reduction and stabilization with the patient supine. CONCLUSIONS: Positioning the patient prone simplifies the reduction and provides adequate exposure to insert Kirschner wires safely from both medial and lateral aspects. Positioning the C-arm is easily achieved, and good radiographs are obtained without disturbing the reduced fracture. LEVEL OF EVIDENCE: Level III.