scholarly journals 8-Year-Old Child with Cerebral Palsy Treated with Pelvic Osteotomies Using 3.5 MM Blade Plate Having Subsequent Bilateral Implant Aseptic Loosening: A Case Report

2021 ◽  
Author(s):  
Ahmed Nahian ◽  
Julieanne P. Sees
Keyword(s):  
Cerebral Palsy ◽  
Aseptic Loosening ◽  
Hip Joints ◽  
Neck Shaft Angle ◽  
Blade Plate ◽  
Muscle Balance ◽  
Blade System ◽  
Shaft Angle ◽  
Neurological Insult ◽  
The Brain

Background: Cerebral palsy (CP) is a central problem of the brain due to neurological insult that affects muscle posture, tone, and movement, resulting in poor motor control and dysfunctional muscle balance affecting hip joints in the growing child. Surgical treatment of hip and, if present, acetabular dysplasia addresses the femoral neck-shaft angle, appropriate muscle lengthening, and deficiency of acetabular coverage, as necessary. The surgeons perform proximal femoral osteotomies (PFOs) mostly with fixed angled blade plates (ABP) with proven success. The technique using an ABP is common and requires detailed attention to perform and to teach. The Case: In this case, an eight-year-old ambulatory patient with CP underwent bilateral proximal varus femoral derotational and pelvic osteotomies for the neuromuscular hip condition with a 3.5 mm Locking Cannulated Blade System (OP-LCP) by OrthoPediatrics Corp instead of the use of the conventional 4.5 mm ABP procedure, resulting in aseptic loosening. Conclusion: Due to the child’s underdeveloped posture, the surgeon utilized the 3.5 mm instrumentation for a child-size implant, which worked sufficiently for the surgery but may not have loosened if a similar child-size blade plate system of 4.5 mm screws was implanted. While the ABP and OP-LCP systems are fruitful and safe for internal corrections of PFOs, the OP-LCP system may aid the residents in learning the procedure with higher confidence, fewer technical inaccuracies, and refined outcomes. Both systems are safer and viable for the treatment of neuromuscular hip conditions.

scholarly journals The Method of Determining Clinical and Roentgenogrammetric Indicators of Hip Joint in Patients with Cerebral Palsy

2020 ◽  
pp. 35-42
Author(s):  
V.Yu. Hoshko ◽  
N.O. Naumenko ◽  
M.B. Yatsuliak ◽  
A.I. Cheverda ◽  
M.M. Nemesh ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Hip Joint ◽  
Developmental Disorders ◽  
Hip Joints ◽  
Femoral Torsion ◽  
Neck Shaft Angle ◽  
Joint Pathology ◽  
Medical Institutions ◽  
Shaft Angle ◽  
The Subject

Summary. There is no doubt that obtaining the true parameters of the hip joint makes it possible to determine the tactics of treatment of patients with cerebral palsy and it is a relevant object of studying. Objective: to improve the results of diagnostics of pathology of the hip joint in patients with cerebral palsy by developing our own method. Materials and Methods. The study included 20 patients (40 joints): 10 boys and 10 girls. Sixteen joints were operated on. The patients were 3-15 years of age. Femoral torsion according to Ruwe was clinically determined in all the patients; also, our own method for determining the clinical and roentgenogrammetric parameters of the hip joint (utility model patent No. 137567) was used. Results. Our own method is simple, available and cheap; it may be used in all medical institutions with X-ray rooms for the diagnosis of hip joint pathology, as well as for screening. Conclusions. Our own method is simple and reliable for determining the parameters of the hip joint in patients with cerebral palsy (femoral torsion, neck shaft angle, Wiberg's angle, Reimer's index, vertical migration index, acetabular angle, the angle of inclination of the acetabulum) in patients with cerebral palsy. Obtaining radiographic parameters of both hip joints after only one radiograph also significantly reduce the radiation load on the patient, since patients with cerebral palsy are the subject of screening throughout the entire period of their development. This method can be also applied during the examination and screening the patients with developmental disorders and other diseases of the hip joint.

scholarly journals Measuring anteversion and femoral neck‐shaft angle in cerebral palsy

1997 ◽  
Vol 39 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Freeman Miller ◽  
Youhui Liang ◽  
Marco Merlo ◽  
H Theodore Harcke
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
Neck Shaft Angle ◽  
Shaft Angle

scholarly journals Characteristics of hip impingement syndrome in patients with multiple hereditary exostoses

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yeong-Seub Ahn ◽  
Sungmin Kim ◽  
Woo-Jong Kim ◽  
Jun-Hyuk Lim ◽  
Sung-Taek Jung
Keyword(s):  
Femoral Neck ◽  
Alpha Angle ◽  
Hip Joints ◽  
Neck Shaft Angle ◽  
Multiple Hereditary Exostoses ◽  
Hip Impingement ◽  
Morphometric Measure ◽  
Shaft Angle ◽  
Coxa Valga ◽  
Symptom Group

Abstract Backgrounds This study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome. Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. Patients with MHE were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Alpha angle was further evaluated to investigate the FAI using radiographs, and the minimum ischio-femoral distance was further measured to investigate the IFI using computed-tomographic (CT) study. Results On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. Unlike general population, the number of the hip with IFI-symptom was higher than those with FAI symptom in this study. In morphometric evaluation of MHE hips, coxa valga was most prominent deformity with occasional tendency of mild acetabular dysplasia. In a comparison of morphometric study between the impingement symptom group and non-symptom group, the FAI symptom showed significant differences of morphometric measure values than those of the non-symptom group (FAI symptom group vs. Non-FAI symptom group; Femoral neck-shaft angle (153.9 vs 142.6), Sharp’s angle (45.0 vs 41.5), CE angle (21.1 vs 28.8) and alpha angle (76.7 vs 57.9)). Similarly, the IFI symptom group also showed significant differences of morphometric measure values than those of the non-symptom group (IFI-symptom vs. Non-IFI symptom; Femoral neck-shaft angle (150.9 vs 142.7), Sharp’s angle (44.7 vs 41.4), CE angle (21.1 vs 29.3) and alpha angle (73.3 vs 56.8)). In addition, the minimum ischio-femoral distance measured using CT was significantly decreased in the IFI symptom group (IFI symptom group: 6.6, Non-IFI symptom group: 16.4). Conclusion The results suggest that the characteristic deformities represented by coxa valga in the MHE hip act as an offset for FAI symptoms, on the contrary, act as a trigger for IFI symptoms. Level of evidence Level III.

Neurogenic heterotopic ossification: a pictorial review

2019 ◽  
Vol 80 (12) ◽  
pp. 707-710
Author(s):  
Richard McCormack ◽  
Brian McGlone
Keyword(s):  
Heterotopic Ossification ◽  
Hospital Setting ◽  
Clinical Findings ◽  
Rehabilitation Services ◽  
Hip Joints ◽  
Pictorial Review ◽  
Skeletal Site ◽  
Neurological Insult ◽  
The Brain ◽  
Acute Hospital Setting

Neurogenic heterotopic ossification is a condition whereby bone forms in an extra-skeletal site. It may occur in the context of major neurological insult involving the brain or spinal cord. It causes pain and restricts movement, most commonly at the hip joints. Although neurogenic heterotopic ossification is associated with significant morbidity, the diagnosis is not always considered when referring for imaging in susceptible individuals. This article highlights its key features to promote better awareness and recognition, by reviewing clinical findings and imaging of patients across various modalities including plain radiographs, ultrasound and computed tomography. The management of neurogenic heterotopic ossification is limited by late identification and consequently clinicians should always be aware of this potentially significant diagnosis. Recognition in the acute hospital setting before transfer to rehabilitation services may prevent further clinical sequelae including urinary tract infection and pressure ulcers.

scholarly journals Original positioning method to determine the clinical and radiographic parameters of the hip joint in patients with cerebral palsy

2021 ◽  
Vol 13 (4) ◽  
pp. 90-93
Author(s):  
Yatsulіak M ◽  
Nemesh M ◽  
Martsyniak S ◽  
Kabatsiy M ◽  
Filipchuk v
Keyword(s):  
Cerebral Palsy ◽  
Hip Joint ◽  
Developmental Disorders ◽  
Original Method ◽  
Hip Joints ◽  
Femoral Torsion ◽  
Neck Shaft Angle ◽  
Radiographic Parameters ◽  
Medical Institutions ◽  
Positioning Method

Relevance: Obtaining true radiographic parameters of the hip joint helps to choose therapeutic tactics for children with cerebral palsy. Goal of the study: Improvement of the diagnostic results in pathology of the hip joint among patients with cerebral palsy by using our original method. Materials and methods: The number of examined patients – 30 persons (60 joints), 15 boys and 15 girls, 26 joints were operated. The age of patients ranged between 3-15 years. All patients underwent a clinical evaluation – Ruwe's femoral torsion, as well as radiography of the hip joints using our original method (utility model patent №137567). The offered method is cheap, simple and accessible to all medical institutions with an X-ray room, for the diagnosis and screening of pathology of the hip joint. The our original method can be used to determine all the main parameters of the hip joint (femoral torsion, neck-shaft angle, Viberg angle, Reimers’ index, acetabular angle, Sharp’s angle) in patients with cerebral palsy. Making only single radiograph, one obtains true radiographic parameters of both hip joints, which significantly reduces the radiation load upon the patient. Our method can be used in the examination and screening of patients with developmental disorders and other diseases of the hip joint.

scholarly journals Characteristics of Hip Impingement Syndrome in patients with Multiple Hereditary Exostoses

2020 ◽  
Author(s):  
Yeong-Seub Ahn ◽  
Ho-Seok Oh ◽  
Woo-Jong Kim ◽  
Yu-Seok Kim ◽  
Sung Taek Jung
Keyword(s):  
Alpha Angle ◽  
Impingement Syndrome ◽  
Morphometric Study ◽  
Hip Joints ◽  
Neck Shaft Angle ◽  
Hip Impingement ◽  
Significant Difference ◽  
Shaft Angle ◽  
Coxa Valga ◽  
Symptom Group

Abstract BackgroundsThis study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome.Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Hip impingement symptoms were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. Alpha angle was evaluated to investigate the FAI. The minimum ischio-femoral distance was measured to evaluate for IFI using computed-tomographic study. Each measured morphometric study was compared according to gender, location and hip impingement symptom.Results Coxa valga and acetabular dysplasia were common with a mean femoral neck-shaft angle of 144.1°, mean CE angle of 27.9°, and mean Sharp’s acetabular angle of 42.0°. Each of the measured value for assessment of hip deformity was correlated significantly. Morphometric study on gender showed no significant difference except the alpha angle value. In addition, no significant difference was shown on comparison study by location of hip. On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. The number of hip joints with IFI symptom was higher than those with FAI symptom in this study. Furthermore, both the FAI and IFI symptom group showed significant differences from the non-symptom group in the morphometric study. In addition, the minimum ischio-femoral distance was significantly decreased in the IFI symptom group, which seems to be associated with coxa valga deformity.Conclusion The results suggest that the characteristic deformities that occur in the hip joint of MHE patients affect the appearance of impingement syndrome. Therefore, it is necessary to carefully evaluate the characteristic deformities of the hip joint in patients with MHE and to set up the treatment modality accordingly.Level of Evidence : Level III, retrospective comparative study

Femoral Anteversion and Neck-Shaft Angle in Children With Cerebral Palsy

1999 ◽  
Vol 364 ◽  
pp. 194-204 ◽  
Author(s):  
Eugene D. Bobroff ◽  
Henry G. Chambers ◽  
David J. Sartoris ◽  
Marilynn P. Wyatt ◽  
David H. Sutherland
Keyword(s):  
Cerebral Palsy ◽  
Femoral Anteversion ◽  
Neck Shaft Angle ◽  
Children With Cerebral Palsy ◽  
Shaft Angle

scholarly journals Substantiation of the method for determining the clinical and radiographic parameters of the hip joint in patients with cerebral palsy

TRAUMA ◽  
2021 ◽  
Vol 22 (1) ◽  
pp. 42-46
Author(s):  
V.Yu. Hoshko ◽  
N.O. Naumenko ◽  
M.B. Yatsuliak ◽  
A.I. Cheverda ◽  
M.M. Nemesh ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Hip Joint ◽  
Neuromuscular Disorders ◽  
Neck Shaft Angle ◽  
Standard Position ◽  
Radiographic Parameters ◽  
Acetabular Angle ◽  
Number Of Patients ◽  
Shaft Angle ◽  
Student’S T

Background. The difficulties of diagnosis that arise when choosing therapeutic measures aimed at preventing sublu-xation, dislocation, and contractures of the hip joint in patients with cerebral palsy are a topical object of the research. The purpose was to improve the results of the diagnosis of the hip joint pathology by establishing objective radiographic parameters. Materials and methods. The total number of patients was 20 (40 joints), 10 boys and 10 girls aged 3 to 15 years. Sixteen joints were operated. Radiographically, we have determined neck-shaft angle and torsion of the thigh, projection and true according to Koval (using tables), acetabular angle, angle of inclination (Sharpe’s angle). Hip torsion was determined clinically according to Ruwe. Torsion was evaluated intraoperatively in our own way (patent No. a200512793). All patients were examined using our method (patent No. 137567). Results. Using the Student’s t-test for independent samples, the parameters of the hip joints were compared and significant differences were found between the neck-shaft angle in the standard position and the neck-shaft angle in our own position (p < 0.05), as well as between the neck-shaft angle in the standard position and the neck-shaft angle true according to Koval (p < 0.05). According to Fisher’s test, it was found that the torsion according to Ruwe and the torsion according to Koval are significantly different (p < 0.05): Femp 1.87 > Fkr 1.7. Using the method of odds ratio (OR), we determined that the sensitivity of torsion measurement by Ruwe was 0.7, the specificity of torsion measurement by Ruwe was 0.83 (OR = 11.67, confidence interval [1.94–70.18]) indicating that the chance of getting a coincidence by measuring torsion by Ruwe is 11.67 times higher than accor-ding to Koval, compared with intraoperative data. A well-defined amount of torsion of the thigh according to Ruwe provides true indicators of the hip joint using our own method. Conclusions. The own method provides the determination of objective clinical and radiographic (diagnostic) parameters in patients with patho-logy of the hip joint. When performing one roentgenogram, it is possible to define all basic parameters of the hip joint (torsion of the hip, neck-shaft angle, Wiberg’s angle, Reimers’ index, index of vertical migration, acetabular angle, angle of inclination) and to standardize examinations of patients with cerebral palsy who are subject to screening throughout the whole period of their development. In this way, you can get radiographic indicators of patients with severe neuromuscular disorders (Gross Motor Function Classification System levels III and IV).

Sign in / Sign up

Export Citation Format

Share Document