scholarly journals Paralytic dislocations of the hip in adolescence: Orthopaedic treatment

2009 ◽  
Vol 137 (11-12) ◽  
pp. 697-701
Author(s):  
Goran Cobeljic
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Walking Ability ◽  
Lower Side ◽  
Leg Length ◽  
Bone Surgery ◽  
Tractus Iliotibialis ◽  
Ambulatory Patients ◽  
Soft Tissue Surgery ◽  
Dislocation Of The Hip

Paralytic dislocation of the hip in adolescence is not typical, but presents a serious problem whether diagnosed primarily in adolescence or due to the lack of treatment or failed treatment in earlier age. It is characteristic of cerebral palsy and myelomeningocele. If the paralytic dislocation of the hip in adolescence is asymmetric, then pelvic obliquity, leg-length discrepancy, imbalance in sitting position, scoliosis and secondary spondylosis with all its consequences ensue. Complications like hip pains due to secondary arthrosis and walking ability impairment are frequent in ambulatory patients. The dislocation is the result of muscle imbalances in the hip region. The diagnosis is based on Illness history, clinical examination, neurological examination and radiography. Treatment is mostly operative, except in cases of pelvic symmetry and absence of difficulties. Pelvic and/or femoral osteotomy with or without open reduction of the hip is done in ambulatory patients with cerebral palsy. Soft-tissue surgery, hip flexors release and tenotomy of the hip adductors, are done in non-ambulatory patients with cerebral palsy. In patients with myelomeningocele soft-tissue surgery, hip flexors release and tractus iliotibialis resection on the lower side of the pelvis, are done regardless of the ability to walk. The same bone surgery procedures as in cerebral palsy are done only in ambulatory patients with unilateral dislocations if soft-tissue surgery failed.

Evolution of walking ability after soft tissue surgery in cerebral palsy patients: what can we expect?

2008 ◽  
Vol 17 (3) ◽  
pp. 107-113 ◽  
Author(s):  
Martin Svehlik ◽  
Krystof Slaby ◽  
Libor Soumar ◽  
Pavel Smetana ◽  
Alena Kobesova ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Walking Ability ◽  
Soft Tissue Surgery

scholarly journals Soft tissue surgery as an initial treatment for hip displacement in spastic cerebral palsy

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 38
Author(s):  
Luiz Antônio Angelo da Silva ◽  
Patricia Maria de Moraes Barros Fucs
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Small Sample ◽  
Acetabular Index ◽  
Soft Tissue Release ◽  
Spastic Cerebral Palsy ◽  
Hip Displacement ◽  
Migration Percentage ◽  
Soft Tissue Surgery

Objective: To use the measurement of migration percentage (MP) to evaluate the long-term radiographic results of soft tissue surgery as the first treatment for hip displacement in spastic bilateral cerebral palsy. A secondary objective was to identify predictive factors of stability (i.e., less than 30% of MP in the long term), after surgical correction. Methods: In this longitudinal cohort study, we reviewed the electronic medical records and radiographs of all consecutive patients with cerebral palsy operated for the correction of hip displacement between 1984 and 2013 in a referral orthopedic public hospital in Brazil. Patients were included if they had received, as the first surgical procedure, soft-tissue release. All surgeries were bilateral and symmetrical. We used the available radiographs to evaluate the migration percentage (MP), acetabular index (AI), pelvic obliquity (PO) angle, head-shaft angle (HSA), congruence and femoral head sphericity, and function using the GMFCS (Gross Motor Function Classification System). Results: we included 93 patients, all operated before being 12 years old, with follow-up of 10 years in average, 73 (78%) of them with good results (MP < 30%). We found association between preoperative MP ≤ 40%, AI ≤ 25°, and postoperative symmetry with good results, with a cut-off value of 38% of MP and 27° of acetabular index being predictive. Discussion: The role of soft tissue releases remains controversial owing to small sample sizes, heterogeneity, variety range of ages, definitions used for outcome, and lack of statistical quality. Our results were better in combined tenotomies, in diparetic patients aged more than six years, and in patients with lower initial values of MP and AI. Radiographic variables had good correlation with each other and association with results, with cut-off values for MP and AI PRE.

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.

The Hip in Children With Cerebral Palsy: Predicting the Outcome of Soft Tissue Surgery

1997 ◽  
Vol 340 ◽  
pp. 165-171 ◽  
Author(s):  
Mark S. Cornell ◽  
N. Cameron Hatrick ◽  
Roslyn Boyd ◽  
Gillian Baird ◽  
John D. Spencer
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Children With Cerebral Palsy ◽  
Soft Tissue Surgery

scholarly journals Lower extremity soft tissue surgery in spastic cerebral palsy: experience from a government rehabilitation unit

2018 ◽  
Vol 4 (2) ◽  
pp. 214
Author(s):  
Adiveppa Hosangadi ◽  
Anand Varma ◽  
Surykanth Kalluraya
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Lower Limb ◽  
Operative Procedure ◽  
Lower Limbs ◽  
Spastic Cerebral Palsy ◽  
Functional Abilities ◽  
Rehabilitation Unit ◽  
Lower Limb Surgery ◽  
Soft Tissue Surgery

<p class="abstract"><strong>Background:</strong> <span>Spastic cerebral palsy (CP) remains the most common type of CP and may be managed surgically or non-surgically depending upon its severity. Recent advances have replaced single-level surgery by the concept of multilevel surgery where multiple levels of musculoskeletal pathology, in one/both lower limbs, are addressed during one operative procedure, requiring only one hospital admission and one period of rehabilitation. This study assessed the outcome of lower limb soft tissue surgery in children with spastic CP in a government rehabilitation unit and measured its feasibility with limited infrastructure facilities and patient compliance</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span>The study comprised of 26 patients aged between 2-12 years. Physical examination and GMFCS scores were recorded and evaluation of sitting balance, standing balance and gait were done. Musculotendinous soft tissue lower limb surgery was performed at one or more levels unilaterally or bilaterally and the results were interpreted</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span>Complete or near complete correction of deformities were attained by all children postoperatively. Significant improvements were noted in the gross motor functional classification system (GMFCS) scores. All parents and children were satisfied with the surgical outcome and reported improvement in functional abilities and locomotion in the follow-up along with better quality of life and mobility</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span>Lower limb soft tissue surgery is a valuable aid in improving functional abilities and locomotion in children with spastic CP. Surgery should be undertaken depending upon clinical indications and can be successfully carried out in government hospitals with ordinary infrastructure in developing countries as well</span><span lang="EN-IN">.</span></p>

Kinematic and Kinetic Outcomes After Identical Multilevel Soft Tissue Surgery in Children With Cerebral Palsy

2007 ◽  
Vol 27 (6) ◽  
pp. 658-667 ◽  
Author(s):  
Stephen E. Adolfsen ◽  
Sylvia Õunpuu ◽  
Katharine J. Bell ◽  
Peter A. DeLuca
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Children With Cerebral Palsy ◽  
Soft Tissue Surgery
Sign in / Sign up

Export Citation Format

Share Document