scholarly journals Medial rotation deformity of the hip in cerebral palsy: Surgical treatment by derotation femoral osteotomy

2004 ◽  
Vol 51 (3) ◽  
pp. 29-35
Author(s):  
Goran Cobeljic ◽  
I. Djordjic ◽  
Zoran Bajin ◽  
Zoran Vukasinovic ◽  
Aleksandar Lesic
Keyword(s):  
Cerebral Palsy ◽  
Excellent Result ◽  
Original Method ◽  
Precise Determination ◽  
Femoral Osteotomy ◽  
Before And After ◽  
Medial Rotation ◽  
Derotation Osteotomy

Medial rotation deformity of the hip is a problem to patients handicapped by cerebral palsy who are able to walk, because the knees point inward during gait ("kissing patellae") and cause falls and frequent injuries, knee and ankle distorsions. The deformity is a result of an increased femoral neck anteversion. The purpose of the paper is to present the results of an original method of precise determination of the degree of rotation for derotation femoral osteotomy. Indications for this operation were set in pa- tients with spastic form of cerebral palsy over 10 years of age, able to walk, who had difficulties in gait and whose lateral rotation was less than 15 along with the medial rotation of over 70 in the hip on the side of the deformity. Twenty hips in 17 patients able to walk were operated on. The average age was 21 (11 - 42), the average follow-up was 11 years (3-17). The assessment of the results was based on the comparison of the rotational abilities of the hip and individual problems before and after the operation. Excellent result was achieved in 12 (70.6%) patients i.e. 15 (75%) hips; good result was achieved in 3 (17.6%) patients i.e. 3 (15%) hips; unsuccessful result in 2 (11.8%) patients i.e. 2 (10%) hips. Complications aroused in 6 patients i.e. 6 (30%) hips. The conclusion is that derotation osteotomy of the femur is a successful procedure for the treatment of the medial rotation deformity of the hip in patients with the spastic form of cerebral palsy who are able to walk. The above mentioned indications must be respected and the original method of determining the degree of derotation applied. Due to a relatively high percentage of complications, e.g. osteitis, the operation is suggested to patients aged 10 to 15 when possible complications can more easily be cured.

scholarly journals Medial rotation deformity of the hip in cerebral palsy: Surgical treatment by transposition of gluteal muscles

2005 ◽  
Vol 133 (1-2) ◽  
pp. 36-40 ◽  
Author(s):  
Goran Cobeljic ◽  
Zoran Bajin ◽  
Zoran Vukasinovic ◽  
Aleksandar Lesic ◽  
Momirka Vukicevic
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
External Rotation ◽  
Gluteus Medius ◽  
Flexion Contracture ◽  
Femoral Neck Anteversion ◽  
Before And After ◽  
Medial Rotation ◽  
Lateral Rotation ◽  
The Difference

INTRODUCTION Medial rotation deformity of the hip is a problem to patients who are handicapped by cerebral palsy but able to walk, because the knees point inward during gait (?kissing patellae") and cause falls and frequent injuries. Knees and ankles are subject to stress and, therefore, they assume compensating positions. Lower legs assume position of valgus and external rotation, whereas feet rotate either inwards or outwards. Secondary deformities make gait more difficult and cause rapid tear of footwear. AIM The purpose of the paper was to retrospectively analyze the effects of transposition of the gluteus medius and minimus muscles, a procedure introduced for the first time in our country in order to correct the deformity. A new method of binding the muscles by wire was described. There had been no previous experience with this method. METHOD This operation was indicated in patients with spastic form of cerebral palsy, who were able to walk, who had difficulties in gait and whose lateral rotation was less than 10? along with the medial rotation of over 70? of the hip on the side of the deformity. Additional prerequisite for the operation was the absence of flexion contracture of more than 15? of either the hip or the knee on the side of deformity, as there is possibility of aggravation of the flexion hip deformity due to transposed gluteal muscles (now in front of the hip joint). Fifteen hips of 10 patients were operated on. Five patients were operated on bilaterally at one time. The average age was 8 (6-12) years. The majority of patients, 8 (80%) were aged between 6 and 8. The average follow-up was 5 years (3-8). The assessment of the results was based on the comparison of rotational abilities of both hips before and after the operation (in unilateral and bilateral deformities), as well as on individual complaints before and after the operation. In patients with unilateral deformity, their ?healthy" hips were the control hips. The analysis of the femoral neck anteversion before and after operation was performed. RESULTS Average values of medial and lateral rotation of the deformed hips before operation exhibited significant statistical difference when compared to control hips. The difference of average values of rotatory movements of control and operated hips was not statistically significant after operation. The difference of average preoperative values of the femoral neck anteversion in hips with deformity was statistically significant (49.40?4.63? compared to 32.8?3.1G). Postoperative average values of anteversion in operated and control hips were not statistically significant. The difference between average preoperative (49.40?4.63?) and postoperative (35.80?7.66?) values of the femoral neck anteversion was statistically significant. Excellent results were achieved in 5 (50%) patients, i.e. 8 (53.3%) hips; good results were achieved in 3 (30%) patients, i.e. 5 (33.3%) hips; poor result in 2 (20%) patients, i.e. 2 (13.3%) hips. All 5 patients who had undergone surgery of both hips had symmetric outcome. Three patients had excellent results, while two had good results. Patients with excellent and good results (80% of patients, 86.6% of hips) showed neither weakening of the operated hip abduction nor pelvic instability (positive Trendelenburgh hip test). No complications were recorded postoperatively. CONCLUSION Transposition of gluteal muscles can be recommended in patients under 10 years of age as there is still a chance for their femoral neck to change orientation, to decrease the anteversion and thus to achieve long-lasting effect. Fixation of transposed muscles by wire proved to be effective.

scholarly journals Paraliticka dislokacija kuka kod cerebralne paralize - hirursko lecenje mekotkivnim postupcima

2005 ◽  
Vol 52 (2) ◽  
pp. 49-53
Author(s):  
Goran Cobeljic ◽  
Zoran Bajin ◽  
S. Milickovic ◽  
Aleksandar Lesic ◽  
O. Krajcinovic
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Excellent Result ◽  
Radiological Finding ◽  
Radiological Findings ◽  
Knee Contracture ◽  
First Time ◽  
Dislocation Of The Hip ◽  
Knee Flexors

Results of a combination of soft tissue procedures performed for the first time in treating paralytic dislocation of the hip in cerebral palsy are presented. All hip flexors and adductors release, along with possible transposition or elongation of knee flexors on the side of the dislocation (if knee contracture exceeded 20) were performed. 75 hips in 57 patients were operated on. 54 patients were analyzed. The average age of the patients was 6.6 years, the average follow-up was 7 years. Excellent result was achieved in 33patients (61%), good in 10 (18,6%), fair in 4 (7,4%) poor in 7 patients (13%). Poor results were registered in patients over 10 years of age and in patients with athetosis. Results were assessed according to clinical finding, radiological finding (migrational percentage) and the ability of patients to walk. When based on radiological findings only, excellent results were achieved in 63 hips (84%). This combination of soft-tissue procedures which includes all muscles that take part in the dislocation proved to be very successful in achieving reposition. It can be recommended to patients suffering from the spastic form of cerebral palsy up to 10 years of age.

scholarly journals Cycloplegic Effects on the Cylindrical Components of the Refraction

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Athar Zareei ◽  
Milad Abdolahian ◽  
Shahram Bamdad
Keyword(s):  
Precise Determination ◽  
Lower Amount ◽  
Healthy Individuals ◽  
Male And Female ◽  
Near Vision ◽  
Before And After ◽  
The Mean ◽  
The Right ◽  
Age Range

It is important to predict which astigmatic patients require separate refraction for near vision. This study compared cylindrical components changes by cyclopentolate 1% for the low and high amount of astigmatism. The right eyes of 1014 healthy individuals (307 males and 707 females) with cylindrical refractive power more than −0.5 diopter on autorefractometer were selected. Both male and female patients in the age range of 17–45 years were refracted before and after cycloplegia, using 1% cyclopentolate. All volunteers were classified into 2 subgroups including the lower astigmatism group (−2.25 to −0.50) and the higher astigmatic group (−2.50 to over). Alpines’ method was used to compare the effect of cycloplegic drop on cylindrical power. The mean age in the lower astigmatism group (29.58; 95% CI: 29.18 to 29.99 years) was not significantly different from the higher astigmatic group (29.85; 95% CI: 29.07 to 30.62) and there were no significant differences in gender between these two groups ( P = 0.54 ). Differences between wet and dry refraction in J0 (−0.03; 95% CI:−0.06 to −0.008) and J45 (−0.03; 95% CI:−0.06 to −0.01) were significant only in the higher astigmatic group. Axis changes by the cycloplegic drop in the lower astigmatism group were 3.51 (CI: 3.22 to 3.81) and axis changes by the cycloplegic drop in the higher astigmatism group were 2.21 (CI: 1.73 to 2.49). In patients with a lower amount of astigmatism (−2.25 to −0.50), additional near subjective refraction could be done for precise determination of axis and in patients with a higher amount of astigmatism (−2.50 to over), near subjective refraction might be done for precise determination of power.

scholarly journals Choice of operative procedures to correct equinus deformity in patients with cerebral palsy

2006 ◽  
Vol 53 (4) ◽  
pp. 21-26 ◽  
Author(s):  
G. Cobeljic ◽  
Z. Vukasinovic ◽  
M. Apostolovic ◽  
Z. Bajin
Keyword(s):  
Cerebral Palsy ◽  
Achilles Tendon ◽  
Operative Treatment ◽  
Triceps Surae ◽  
Visual Evaluation ◽  
Tendon Lengthening ◽  
Before And After ◽  
Achilles Tendon Lengthening ◽  
Equinus Deformity

Equinus deformity of the foot presents a great number of difficulties to ambulant patients with cerebral palsy. Non-operative treatment of the incorrectible - fixed equinus is not successful. Many procedures are applied to treat it operatively, so its not clear which procedure at what age is the most successful. The purpose of this manuscript is to clarify the issue. The results of four procedures are analyzed: aponeurectomy of m. gastrocnemius, Achilles tendon lengthening by z-plasty, a combination of these two procedures and sliding elongation of m. triceps surae. The analysis was based on 417 operations in 291 patients of the average age of 9 years (1-64). The average follow-up was 7 years. The assessment of the results was based on the visual evaluation of the gait, on pedoscope prints and on comparison of ankle movements before and after operation. The analysis shows that the best results were achieved by sliding elongation of m. triceps surae after the age of 7.

scholarly journals Proximal femoral derotation osteotomy in children with CP : long term outcome and the role of age at time of surgery

2021 ◽  
Vol 87 (1) ◽  
pp. 167-173
Author(s):  
Lieven Vermuyten ◽  
Katleen Desloovere ◽  
Guy Molenaers ◽  
Anja Van Campenhout
Keyword(s):  
Cerebral Palsy ◽  
Beneficial Effect ◽  
Kinematic Parameters ◽  
Quantitative Evidence ◽  
Time Of Surgery ◽  
Derotation Osteotomy ◽  
Kinematic Evaluation ◽  
Hip Rotation

The femoral derotation osteotomy (FDO) is seen as the golden standard treatment in children with cerebral palsy and internal rotated gait. This study provides quantitative evidence in support of the beneficial effect of FDO after long term follow up. Retrospective clinical and kinematic evaluation of 31 CP patients (55 operated limbs) pre-, 1 and 3 years postoperatively after proximal FDO was conducted for a minimal follow-up of 3 years. This group con- sisted of 20 men and 11 women, aged 10.68±3.31 years at the time of surgery. Minimum follow up was 3 years (3.16±0.53 years), with 22 patients (38 operated limbs) having an additional follow up at 5 years (5.02±0.49 years). Age at FU3 and FU5 was 14.06±3.52 years and 15.39±3.08 years respectively. A set of clinical and kinematic parameters were ana- lyzed and showed a significant correction of mean hip rotation and femoral anteversion after FDO. Further plotting of individual data comparing 3 or 5 year postoperative values to 1 year postoperative values showed no further significant changes, indicating sustained correction of internally rotted gait until end of our follow up. Plotting mean hip rotation in stance as well as kinematic knee parameters according to age grouped cohorts could not show age at time of surgery to be a significant factor in recurrence of internally rotated gait or preoperative disturbances of knee motion in the sagittal plane. This study provides quantitative evidence on the beneficial effect of FDO, a surgical technique to improve internally rotated gait in cerebral palsy patients with spastic diplegia. Pre- and postoperative clinical and kinematic parameters are compared and results are discussed. Minimum follow up was 3 years with a mean follow up of 4.65±0.83 years. The effect of age at time of surgery on recurrence and kinematic parameters were studied.

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