Objective: To evaluate the effectiveness of distal rectus femoris (RF) release versus transfer to treat gait abnormalities of the knee in ambulatory children with cerebral palsy.

Methods: Ninety-three children were included in this study. Thirty-two patients underwent RF transfer at a mean age of 11.8 years and sixty-one underwent distal RF release at a mean age of 12.5 years. Indications for surgery included RF contractures, abnormal RF activity during swing phase (EMG) and kinematic characteristics of stiff-knee gait. All patients had pre–and postoperative 3D gait analysis and EMG at one year follow up. To evaluate outcomes, patients were grouped by pre-operative knee kinematics (swing-phase peak knee flexion (PKF) < 50º or PKF > 50º occurring later than 77% of the cycle). All data was analyzed statistically.

Results: For the group of patients with PKF< 50º, this value increased significantly after RF transfer (p=.005) and after RF release (p=.03). Children with PKF later than 77% of the cycle also showed significant improvement after both procedures (p=.001; p=.02). All patients experienced a significant decrease of muscle contractures.

Discussion: According to the results of this study, both RF transfer and release brought significant results. We opt for distal RF release, since is technically easier, particularly when one-stage multilevel procedures are being performed.

Purpose of the study: We present a review of the two-year outcome of a new clinical sacroiliac fixation technique used in our first seven patients.

Material and methods: Between May 2002 and March 2003, seven patients with a Tile C fracture of the pelvic girdle were stabilized with a new operative technique. This technique used two sacral screws linked to two iliac expansive screws via a 5.5 mm rod. Three of the patients presented preoperative neurological injuries attributed to the trauma (L5 or S1 paralysis). All presented associated lesions: lower limb (n=3 patients), spine (n=2), acetabulum (n=2). Mean patient age was 36.3 years. We present a retrospective clinical and radiological review of these seven cases. The Majeed score, the radiological index of lower limb length, and the combined index of vertical displacement and sacroiliac CT results were noted.

Results: The mean Majeed score was 93. Reduction of the combined vertical displacement was considered excellent or good (< 10 mm) in all patients; The reduction in the leg length discrepancy was considered good for all patients. There was no loss of reduction at last follow-up. There were no septic or skin complications and no complications related to implanted material. The implants were removed in one patient. The sacroiliac CT revealed formation of ossification bridges in all patients.

Discussion: The results of our small series are encouraging, particularly for vertical stability over time. There was no case of lysis around the screws and the clinical results were satisfactory.

Conclusion: For us, this technique is the optimal method for the treatment of Tile C injury to the pelvic girdle. This technique enables vertical stabilization while maintaining a certain degree of horizontal mobility facilitating reduction and fixation of the associated anterior injuries. This technique has its limitations since it is not particularly adapted for posterior lesions with fracture of the sacrum in Denis zone 2. These early encouraging results will require further long-term assessment in a larger group of patients.