Comparison of Proximal and Distal Rotational Femoral Osteotomy in Children With Cerebral Palsy

Kay, Robert M.; Rethlefsen, Susan A.; Hale, Julia M.; Skaggs, David L.; Tolo, Vernon T.

doi:10.1097/01241398-200303000-00003

Cited by 63 publications

(90 citation statements)

References 21 publications

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“…It can be carried out at the inter-trochanteric level (proximal FDO) or at the supracondylar level (distal FDO) [16,17]. There is agreement that both methods provide comparable static and functional results but that distal osteotomy is less complicated [4,16,18]. However, recent studies have shown a high rate of over-and undercorrection [2] and recurrence [19][20][21] of IRG following FDO in contrast to previous studies [4].…”

Section: Introductionmentioning

confidence: 46%

“…However, FDO still represents the golden standard for the treatment of internal rotation irrespective of the underlying causes. Improvements in anteversion have been described in several other reports [6,[16][17][18]. In previous studies, a high rate of over-and under-correction and a high variance of the results of mean hip rotation in stance in the 3D gait analysis after FDO have been shown [2].…”

Section: Discussionmentioning

confidence: 89%

“…However, a discrepancy was found between the intraoperative extent of derotation and the decrease in anteversion as [18,20]. IRG is a multi-factorial problem, there are static (torsion of femur and tibia) and dynamic (spasticity of the glutei and equinus foot) components.…”

Section: Discussionmentioning

confidence: 99%

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Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Braatz

Wolf

Gerber

et al. 2013

International Orthopaedics (SICOT)

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Purpose Femoral derotation osteotomy (FDO) is commonly used to correct internal rotation gait (IRG) in spastic diplegia. The purpose of this study was to investigate whether the extent of intraoperative derotation is reflected in changes in static (clinical ROM and anteversion angle measured on torsional MRI) and dynamic parameters (transverse plane kinematics in three-dimensional gait analysis) after FDO in children with spastic diplegia. Methods In a prospective study, 30 children with spastic diplegia and IRG were treated with FDO as part of a multilevel surgery and were examined pre-and postoperatively clinically, by three-dimensional gait analysis and by torsional MRI according to a standardised protocol. Results A correlation (r=0.317, p=0.015) between the extent of intraoperative derotation and mean hip rotation in stance as well as the anteversion angle measured on torsional MRI (r=0.454, p<0.001) was found. However, no significant correlation was observed between anteversion angle (tMRI) and mean hip rotation in stance, either before or after FDO. Conclusions Significant improvements were found in IRG after FDO, confirming the results of previous studies. There was no correlation between the anteversion measured on MRI and the mean hip rotation in stance in 3D gait analysis before or after FDO. Thus, the data suggest that if the intraoperative extent of derotation is determined only by the anteversion angle, the result will not be better after FDO. It might only help to avoid retroversion and indicate the maximum amount of femoral derotation. In this study the extent of the intraoperative derotation was orientated at the preoperative midpoint of rotation. Based on the small, but significant correlation between the clinical midpoint and the mean hip rotation in stance in the gait analysis, determination of the intraoperative extent of derotation according to the mean hip rotation in stance seems to give the best results.

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Section: Introductionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 89%

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Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Braatz

Wolf

Gerber

et al. 2013

International Orthopaedics (SICOT)

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“…There have been several reports on femoral derotational osteotomy to correct internal rotation gait of children with cerebral palsy [8][9][10][11][12] . However, there have been relatively few reports on the contribution of internal tibial torsion to intoeing by children with cerebral palsy.…”

Section: Discussionmentioning

confidence: 99%

Causes of Intoeing Gait in Children With Cerebral Palsy

Rethlefsen

Healy

Wren

et al. 2006

The Journal of Bone and Joint Surgery-American Volume

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“…Intertrochanteric varus osteotomies have been widely used in humans to treat severe slipped capital femoral epiphysis 1 , Legg-Calve-Perthes' disease 2 , and congenital anomalies such as congenital coxa vara 3 and spastic encephalopathy 4 . Surgical interventions, such as osteotomies, stimulate growth in long bones [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Effect of Intertrochanteric Osteotomy on the Proximal Femur of Rabbits: Assessment With Power Doppler Sonography and Scintigraphy

Doria

Cunha

Modena

et al. 2007

Clinics

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1Doria AS, Cunha FG, Modena M, Rodrigues CJ, Garcez AT, Junior RG, Bolliger Neto R, Melo IB, Buchpiguel C, Molnar LJ, Guarniero R. Effect of intertrochanteric osteotomy on the proximal femur of rabbits: assessment with power doppler sonography and scintigraphy. Clinics. 2007;62(6):741-8. OBJECTIVE:In bone injury, repair results in local increased vascularity and bone marrow remodeling. Characterizing the vascular and metabolic imaging patterns of the proximal femur following an intertrochanteric osteotomy may help clinicians decide proper management of the patient. Our objective was to measure Doppler sonography and scintigraphy interval changes in the proximal femur following intertrochanteric osteotomy and compare imaging and histomorphometric measurements in the late post-operative stage (6 weeks after surgery) in a rabbit model of bone injury. MATERIALS AND METHODS: Both hips of 12 adult rabbits were imaged with power Doppler sonography and scintigraphy prior to and after (7 days and 6 weeks) unilateral osteotomy. Accuracy of the imaging methods was evaluated using hip operative status and histomorphometric results (vascular fractional area and number of vessels per area unit) as reference standard measures. RESULTS: A significant difference in the mean number of pixels was noted between operated and non-operated femura in late post-operative power Doppler examinations (P=0.049). Although without reaching statistical significance, the AUC of Doppler measurements (AUC=0.99) was numerically greater than the AUC of scintigraphy measurements (AUC=0.857±0.099) (P=0.15) in differentiating proximal femura with regard to their fractional vascular areas in the late post-operative stage. In contrast, scintigraphy tended to perform better (AUC=0.984±0.022) than Doppler ultrasound (AUC=0.746±0.131) to demonstrate the vascularity intensity per area unit (P=0.07) in the late stage. CONCLUSION: Our results warrant further investigation to determine the value of different imaging modalities for assessment of pathologic changes following hip surgery. Power Doppler sonography demonstrated larger AUCs (representing higher accuracy) for the discrimination of vascular fractional areas and scintigraphy, for discrimination of the number of vessels per area unit.

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Comparison of Proximal and Distal Rotational Femoral Osteotomy in Children With Cerebral Palsy

Cited by 63 publications

References 21 publications

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

Causes of Intoeing Gait in Children With Cerebral Palsy

Effect of Intertrochanteric Osteotomy on the Proximal Femur of Rabbits: Assessment With Power Doppler Sonography and Scintigraphy

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