The purpose of the study was to identify risk factors that are associated with re-displacement of the hip after surgical reconstruction in cerebral palsy. Retrospective review of children with cerebral palsy who had hip reconstruction with proximal femoral varus derotation osteotomy (VDRO) and Dega-type pelvic osteotomy, between 2005–2012, at a UK and European institution, was performed. Patient demographics, GMFCS, clinical and radiological outcome were assessed as well as the presence of pelvic obliquity and significant scoliosis (Cobb angle > 10 degrees). Redisplacement was defined as Reimer's Migration Index (MI) >30% at final follow-up. Logistic regression analysis was used to assess which factors were predictive of redisplacement and adjusted for clustered variables (α = 0.05). Eighty hips were identified in 61 patients. The mean age at surgery was 8.8 years (± 3.3). Mean MI pre-op was 68% (± 23%) and post-op was 8% (± 12%). At a mean follow-up, of 3.2 years (± 2.0), 23 hips had a MI >30%. Of these; five were symptomatic, and one had required a salvage procedure. Metalwork removal was undertaken in 14 hips. Logistic regression demonstrated that the pre-operative MI and the percentage of acute correction were significant predictors of re-displacement. If the pre-operative MI was greater than 65 percent, the odds ratio (OR) for redisplacement was 5.99 (p = 0.04). If correction of the MI was less than 90% of the pre-operative MI, the OR for re-displacement was 4.6 (p = 0.03). Age at the time of surgery, GMFCS, pelvic obliquity and scoliosis were not predictive of re-displacement. These results, firstly, highlight the importance of hip surveillance in children with cerebral palsy to allow timely intervention to ensure adequate radiological outcomes. Secondly, as in developmental hip dysplasia, full concentric reduction is essential to reduce the risk of re-displacement, with its associated clinical consequences.
We describe a novel method to encourage children to weight-bear after frame surgery using a whoopee cushion; the objective of this study is to assess the amount of force taken though a limb using this method. The amount force is required to activate the whoopee cushion is measured when a subject takes weight though a whoopee cushion on a force plate. The speed of the foot in vertical and horizontal planes is assessed with motion analysis to correlate this to the activation of the cushion and is assessed under different conditions, and with different whoopee cushionsPurpose
Design/participants
The purpose of this study was to assess the accuracy of three-dimensional camera technology when monitoring deformity correction by an Ilizarov frame and to compare it to manual measurements. A model consisting of an Ilizarov frame built around an artificial tibia and fibula was used with retro-reflective markers placed on the frame and bones to allow for the positions of each to be detected by the camera system. Measurements made by the camera system were compared to measurements taken manually. In the assessment of frame lengthening, the camera system average error was 2% (SD 2%) compared to 7% (SD 6%) for manual measurement. In the assessment of bone lengthening, the camera system average error was 4% (SD 4%) compared to 34% (SD 8%) for manual measurement. The technology also demonstrated good accuracy in the measurement of angular deformity changes.Purpose
Methods and Results
To assess the risk of early re—dislocation following closed reduction (CR) of the hip for idiopathic developmental dysplasia of the hip (DDH). Review of case notes and radiographs of all who underwent CR for DDH between January 2005 and January 2010 was undertaken. Parameters recorded included sex, side of dysplasia, age at the time of attempted reduction and concomitant complications. The main outcome measure was clinical and radiographic evidence of successful reduction. Early failure of reduction was regarded as loss of concentric reduction requiring an open procedure within a year of CR. CR was performed via a standardised protocol under general anaesthetic, with arthrographic control, adductor tenotomy as required and hip spica application. Post procedure reduction was confirmed with MRI and the spica was maintained for 12 weeks.Purpose of study
Methods
