Subtrochanteric osteotomy effectively treats femoroacetabular impingement after slipped capital femoral epiphysis.

UNLABELLED: Femoroacetabular impingement causing pain and deformity often follows in situ pinning for severe, stable (Grade III) slipped capital femoral epiphysis. We asked whether a transverse percutaneous subtrochanteric osteotomy using external fixation could decrease pain, restore function and motion, and improve radiographic outcome. We performed a transverse subtrochanteric osteotomy with external fixation in 13 patients who had prior in situ pinning for severe slipped capital femoral epiphysis. All patients had decreased function, limited range of motion, pain with ambulation, and a limp after in situ pinning. We evaluated the patients using Southwick's categorical classification. The patients' ages ranged from 11 to 17 years; there were five boys and eight girls. The minimum followup was 32 months (average, 43 months; range, 32-92 months). Considering pain as a criterion, 11 patients had good or excellent results (two fair). Twelve patients had good results (one fair) for function, 11 had good results (two fair) for limping, and 11 had good or excellent results (two fair) for motion. Radiographic parameters showed nine good results and four fair results. Subtrochanteric three-dimensional correction using a percutaneous transverse osteotomy and external fixation effectively improved symptoms of femoroacetabular impingement after pinning of a severe slipped capital femoral epiphysis. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Potential complications of posterior spine fusion and instrumentation in patients with cerebral palsy treated with intrathecal baclofen infusion.

STUDY DESIGN: The authors evaluated a case series of 5 patients with cerebral palsy and a previously placed subcutaneous reservoir for continuous intrathecal baclofen infusion to control spasticity who underwent spinal arthrodesis with posterior instrumentation for progressive neuromuscular scoliosis deformities. OBJECTIVES: To present our preliminary experience and complications with posterior spine fusion in patients with cerebral palsy and continuous intrathecal baclofen infusion and provide a literature review. SUMMARY OF BACKGROUND DATA: Numerous studies have reported complications associated with intrathecal baclofen infusion, many of these catheter-related. Few reports address complications associated with the intrathecal baclofen infusion, including progressive spinal deformities and complications following spinal arthrodesis. METHODS: Five patients with spastic quadriplegia cerebral palsy had spine fusions for progressive neuromuscular scoliosis. The mean age at surgery was 14.5 years. The mean preoperative major curve was 73 degrees and mean pelvic obliquity was 19 degrees . The patients' medical records were reviewed for complications following reinsertion of the intrathecal catheter following posterior spine instrumentation and arthrodesis, and for progression of the neuromuscular scoliosis, before and after intrathecal baclofen infusion was initiated. RESULTS: Two patients presented with low-pressure headaches in the postoperative period, resulting from cerebrospinal fluid leak following subarachnoid catheter reinsertion and posterior instrumentation. Four patients documented progression of the major scoliosis curve after intrathecal baclofen infusion was begun. A mean progression of 44 degrees occurred over a mean period of 11 months before the spinal arthrodesis. CONCLUSIONS: Low pressure headaches resulting from a cerebrospinal fluid leak following catheter reinsertion may occur in the postoperative period. Preoperative concerns with the baclofen pump reservoir placed subcutaneously and pressure sores were not seen with careful prone positioning on a 4-poster frame. Progression of scoliosis in patients with cerebral palsy requiring spinal arthrodesis was demonstrated in 4 of the patients after continuous intrathecal baclofen was started. The progression of the spinal deformity as a consequence of growth, natural history, or the intrathecal baclofen infusion is unknown at the present time.

Slipped capital femoral epiphysis in a child with sickle cell disease.

Slipped capital femoral epiphysis in a child with sickle cell disease has not been reported previously. The diagnostic challenges, role of imaging techniques, and the medical treatment of this patient are discussed. The presentation of acute hip or leg pain in a child with sickle cell disease should alert the treating physician to the possibility of a vaso-occlusive crisis as the likely source of the child's pain. The goal of the current case report is to emphasize the need to maintain a high index of suspicion for other potential causes of hip, thigh, or knee pain such as slipped capital femoral epiphysis in an adolescent. Preoperative and postoperative care for a child with sickle cell disease needs to be modified to minimize the risks of vaso-occlusive complications.