Intertrochanteric Imhäuser osteotomy combined with osteochondroplasty in treatment of moderate-severe stable slipped capital femoral epiphysis: a case series study.

The aim of the study is to assess the safety and efficacy of Imhäuser osteotomy combined with osteochondroplasty in the treatment of moderate-severe stable slipped capital femoral epiphysis (SCFE) on short-term basis. Nineteen patients (20 hips) with moderate-severe stable SCFE were surgically treated by Imhäuser osteotomy combined with osteochondroplasty and followed up for 3-4 years. The cases aged between 12 and 18 years at the time of surgery and complained of a variety of symptoms and signs that included pain, limping, limited range of motion (ROM), and/or abductor weakness. The outcomes were assessed using clinical and radiological parameters as well as functional outcome measures: "Harris hip score" (HHS) and "The Western Ontario and McMaster Universities Osteoarthritis Index" (WOMAC). There were statistically significant improvements in flexion, internal rotation, and abduction ROM. HHS and WOMAC improved significantly with final follow-up scores at 86.76 and 6.4%, respectively. The radiological parameters showed significant improvement regarding Southwick angle (mean 12.8°), alpha angle of Nötzli (mean 29.85°), Hilgenreiner epiphyseal angle (mean 37.65°), neck shaft angle (mean 140.63°), and acetabulo-trochanteric distance (median14.1 mm) at the end of follow-up period. Imhäuser osteotomy combined with osteochondroplasty is a good option in moderate-severe stable SCFE treatment.

Flexion Deformities of the Wrist and Fingers in Spastic Cerebral Palsy: A Protocol of Management.

BACKGROUND: Literature is confusing regarding grading and treatment of flexion deformities of wrist and fingers in spastic cerebral palsy (CP). The most established classification is that described by Zancolli; unfortunately, it has its shortcomings which we experienced in the beginning of our approach to manage this rather difficult deformity. We thus modified Zancolli's classification and developed a classification system and treatment protocol. MATERIALS AND METHODS: Thirty patients with spastic CP were operated upon due to flexion deformity of the wrist and fingers and were included in this study. Age ranged from 4 to 14 years, average 7 years. There were twenty boys and ten girls. RESULTS: The average followup was 18 months (range 9 months - 3 years). The power of wrist dorsiflexion, the "House's classification of upper extremity functional use" and the clinical assessment of hand function were used for evaluation; they improved in all patients and this improvement was statistically significant. In all patients, cosmetic appearance improved without any residual flexion deformity. CONCLUSION: This study introduces a new grading system for flexion deformity of wrist and fingers in spastic CP that correlates with severity of the condition and allows a treatment protocol to be established.