scholarly journals Femoral anteversion and tibial torsion only explain 25% of variance in regression analysis of foot progression angle in children with diplegic cerebral palsy

2013 ◽  
Vol 10 (1) ◽  
pp. 56 ◽  
Author(s):  
Kyoung Min Lee ◽  
Chin Youb Chung ◽  
Ki Hyuk Sung ◽  
Tae Won Kim ◽  
Seung Yeol Lee ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cerebral Palsy ◽  
Femoral Anteversion ◽  
Tibial Torsion ◽  
Foot Progression Angle

Does screw position matter for guided growth in cerebral palsy hips?

2020 ◽  
Vol 102-B (9) ◽  
pp. 1242-1247
Author(s):  
Po-Jen Hsu ◽  
Kuan-Wen Wu ◽  
Chia-Che Lee ◽  
Sheng-Chieh Lin ◽  
Ken N. Kuo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cerebral Palsy ◽  
Femoral Anteversion ◽  
Guided Growth ◽  
Optimal Position ◽  
Cox Regression Analysis ◽  
Screw Position ◽  
Coxa Valga ◽  
Group 2 ◽  
Group 1

Aims Guided growth has been used to treat coxa valga for cerebral palsy (CP) children. However, there has been no study on the optimal position of screw application. In this paper we have investigated the influence of screw position on the outcomes of guided growth. Methods We retrospectively analyzed 61 hips in 32 CP children who underwent proximal femoral hemi epiphysiodesis between July 2012 and September 2017. The hips were divided into two groups according to the transphyseal position of the screw in the coronal plane: across medial quarter (Group 1) or middle quarter (Group 2) of the medial half of the physis. We compared pre- and postoperative radiographs in head-shaft angle (HSA), Reimer’s migration percentage (MP), acetabular index (AI), and femoral anteversion angle (FAVA), as well as incidences of the physis growing-off the screw within two years. Linear and Cox regression analysis were conducted to identify factors related to HSA correction and risk of the physis growing-off the screw. Results A total of 37 hips in Group 1 and 24 hips in Group 2 were compared. Group 1 showed a more substantial decrease in the HSA (p = 0.003) and the MP (p = 0.032). Both groups had significant and similar improvements in the AI (p = 0.809) and the FAVA (p = 0.304). Group 1 presented a higher incidence of the physis growing-off the screw (p = 0.038). Results of the regression analysis indicated that the eccentricity of screw position correlated with HSA correction and increases the risk of the physis growing-off the screw. Conclusion Guided growth is effective in improving coxa valga and excessive femoral anteversion in CP children. For younger children, despite compromised efficacy of varus correction, we recommend a more centered screw position, at least across the middle quarter of the medial physis, to avoid early revision. Cite this article: Bone Joint J 2020;102-B(9):1242–1247.

scholarly journals Evaluation of factors affecting external tibial torsion in patients with cerebral palsy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jae Jung Min ◽  
Soon-Sun Kwon ◽  
Kyu Tae Kim ◽  
Young Choi ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Imaging Study ◽  
Femoral Anteversion ◽  
Affecting Factors ◽  
Tibial Torsion ◽  
Factors Affecting ◽  
3 Dimensional ◽  
Gmfcs Level

Abstract Background Gait deviation and associated torsional problems are common in patients with cerebral palsy (CP). Although femoral anteversion in CP has been extensively reviewed in previous studies, only a few studies have focused on tibial torsion. Therefore, this study aimed to evaluate tibial torsion in patients with CP and investigate the affecting factors. Methods Consecutive patients with cerebral palsy who underwent 3-dimensional computed tomography for the assessment of rotational profiles were reviewed. Femoral anteversion and tibial torsion were measured, and the demographic characteristics of the patients were recorded. A linear mixed model was implemented to overcome the retrospective nature of the study. Results After the implementation of inclusion and exclusion criteria, 472 patients were enrolled for this study. With age, external tibial torsion increased, while femoral anteversion decreased. The factors affecting external tibial torsion were increased femoral anteversion (p = 0.0057), increased age (p < 0.0001), higher Gross Motor Function Classification System (GMFCS) level (p < 0.0001), and involved/uninvolved limbs of hemiplegia (p = 0.0471/p = 0.0047). Conclusions Older age, GMFCS level IV/V, hemiplegia, and increased femoral anteversion were the independent risk factors of increased external tibial torsion; therefore, performing an imaging study is recommended for assessing the extent of tibial torsion in patients with such characteristics.

scholarly journals Development and Validation of a Mobile Application for Measuring Femoral Anteversion in Patients With Cerebral Palsy

2020 ◽  
Vol 40 (6) ◽  
pp. e516-e521
Author(s):  
Ki Hyuk Sung ◽  
Kibeom Youn ◽  
Chin Youb Chung ◽  
Muhammad I. Kitta ◽  
Hendra C. Kumara ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Mobile Application ◽  
Femoral Anteversion ◽  
Development And Validation

Effect of floor reaction ankle–foot orthosis on crouch gait in patients with cerebral palsy: What can be expected?

2017 ◽  
Vol 42 (3) ◽  
pp. 245-253 ◽  
Author(s):  
Harald Böhm ◽  
Hösl Matthias ◽  
Frank Braatz ◽  
Leonhard Döderlein
Keyword(s):  
Cerebral Palsy ◽  
Standard Deviation ◽  
Knee Extension ◽  
Spastic Cerebral Palsy ◽  
Foot Orthoses ◽  
Cross Sectional ◽  
Positive Effects ◽  
Foot Progression Angle ◽  
Ankle Foot Orthoses ◽  
Crouch Gait

Background: Floor reaction ankle–foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait. Their effectiveness is debated. Therefore, the objective of this study is to optimize current prescription criteria for the improvement of crouch gait. Study design: Cross-sectional interventional study. Methods: A total of 22 patients with bilateral spastic cerebral palsy, between 6 and 17 years, Gross Motor Function Classification System II–IV participated in this study. Instrumented gait analysis was done under three conditions: barefoot, shoed, and with orthotics. Patients were divided into two groups: good and non-responders with more and less than 8.8° improvement of knee extension during walking, respectively. A multiple predictor analysis was done on parameters that were different between groups. Results: In total, 12 of 22 patients showed good response in knee extension with a mean change of 17° (standard deviation = 5°). Good responders showed a significantly smaller walking velocity, knee extension strength, ankle plantarflexion strength, and greater external foot progression angle compared to non-responders. Foot progression angle together with ankle plantarflexion strength explained 37% of the variance in improvement of knee extension. Conclusion: With appropriate patient selection, an improvement of crouch gait by ankle–foot orthoses of 17° (standard deviation = 5°) can be expected. Patients with slow velocity, weak plantarflexors, and external foot progression benefit most. Joint contractures were no contraindications. Clinical relevance This study showed that gait in patients with low functional level benefit most from ankle–foot orthoses. Unlike in patients with higher functional status, contractures of hip, knee, and ankle did not reduce the positive effects on gait. The suggested prescription criteria may help to better select appropriate patients for orthotics.

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