Surgical Management for Displaced Femoral Head in Cerebral Palsy
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- Category: Vol. 85, March 2017
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Surgical Management for Displaced Femoral Head in Cerebral Palsy, NAGUIB BASHA, MOHAMED HEGAZI, MOHAMED TAG EL-DIN, ASSEM BASTAWISY, EBEED YASIN, EL-SYAYED MAHGOUB, AHMED TAMER and HOSSAM EL-DIN ABDO
Abstract
Background: Cerebral palsy is a disabling disease caused by a non-progressive insult to a growing brain, causing a motor dysfunction that may or may be not associated with sensory and intellectual abnormalities.
Objective: Assessing the effectiveness of surgical treatment of subluxated femoral head in spastic cerebral palsy patients, in improving the growth motor function classification score, the migration percentage, and the acetabular index correlate these measurements to hip pain.
Patients and Methods: The study included 30 hips in 26 patients. All subjects were subjected to full history taking, through clinical examination, calculation of the growth motor function classification score. Laboratory investigations were performed. Radiological assessment was done for all patients including the migration percentage, and the acetabular index. All patients underwent soft tissue release in the form of adductor longus, brevis, and gracillis release. Varus derotation osteotomy and dega pelvic osteotomy were also added to the surgical management.
Results: Patients had a significant improvement of the growth motor function classification score from (4.38) preop-erative to (4.08) post-operative and improvement of acetabular index values preoperative and post-operative from (34.98) to (19.54). Also, migration percentage values preoperative and post-operative were (64.08) and (12.14) respectively. In our patients, stable reduction of the femoral head was followed by a remarkable improvement in abduction. Furthermore, this was achieved without increased pain because of the release of contracted muscles and the increased stability of the hip joint as well as improved comfort in the seated position. Four patients failed to achieve comfortable sitting, two of them experienced the same degree of pain as they had preoperatively.
Conclusion: Once hip subluxation occurs in spastic cere-bral palsy patients, muscle release should be combined with a varus, shortening osteotomy and in acetabular insufficiency, pelvic osteotomy is necessary to obtain the stability.