Derotational Subtrochanteric Osteotomy and External Fixation for the Treatment of Neurogenic Hip Dislocation in Children with Cerebral Palsy: Could This Be a Viable Method of Treatment?
| Autor: | Angelis S; Surgical Anatomy, National and Kapodistrian University of Athens Medical School, Athens, GRC.; Orthopaedics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC.; Orthopaedics, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC., Vynichakis G; Orthopaedics, General Hospital of Piraeus Tzaneio, Piraeus, GRC.; Orthopaedics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC.; Surgical Anatomy, National and Kapodistrian University of Athens Medical School, Athens, GRC., Trellopoulos A; Orthopaedics, Hygeia Hospital, Athens, GRC.; Orthopaedics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC., Apostolopoulos A; Orthopaedics, East Surrey Hospital/Surrey and Sussex Healthcare National Health Service Trust, Redhill, GBR., Filippou D; Surgery, National and Kapodistrian University of Athens Medical School, Athens, GRC., Salmas M; Orthopaedics, National and Kapodistrian University of Athens Medical School, Athens, GRC., Chandrinos M; Orthopaedics, General Hospital of Piraeus Tzaneio, Piraeus, GRC.; Orthopaedics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC., Balfousias T; Orthopaedics, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC., Palaiodimos L; Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA., Kyriazi N; Orthopaedics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC., Michelarakis J; Orthopaedics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2020 Mar 27; Vol. 12 (3), pp. e7437. Date of Electronic Publication: 2020 Mar 27. |
| DOI: | 10.7759/cureus.7437 |
| Abstrakt: | Purpose The treatment of painful and chronic dislocated hip in children with severe cerebral palsy (CP) is particularly demanding and controversial. Numerous surgical techniques have been described, and their outcomes vary a lot. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy (VDSO) and external osteosynthesis: (VDSOEO). Methods Six non-ambulatory children with spastic quadriplegia and chronic dislocated painful hips were treated. The technique involved a small incision on the subtrochanteric site of the osteotomy, followed by retention with a single-sided external osteosynthesis with rotational correction capability [swiveling clamp (SC)] for the reduction of the femur head in the acetabulum, and finally by the osteotomy. Hardware was removed without a second intervention four-six months postoperatively and after the osteotomy was healed. Evaluation of the method was based on clinical, functional, and radiological criteria. Results Four patients achieved improved radiological scores. Two patients demonstrated resubluxation during the period of the osteotomy's healing process. However, no patients experienced pain, and all were able to sit post-surgery, while caregivers reported improved capacity for nursing care. Conclusions It is our strong belief that this approach can improve the quality of life in children with severe CP and painful and chronic dislocated hips. It is a viable and definitely less invasive procedure than classic pelvic or femur osteotomies. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2020, Angelis et al.) |
| Databáze: | MEDLINE |
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