VDRO and Pelvic Osteotomy for Management of Unilateral Hip Dislocation in Spastic CP
|IJOCP | Volume 2015| Issue – April 2015| Page
Conference: Poona Orthopaedic Society Annual Conference POSAC-2015, India [Click for Full details]
Address of correspondence:
Aims and Objectives:
Hip dislocation is a disabling problem in children with Cerebral Palsy. The incidence is more in quadriplegics and non-walkers. Hip dislocation causes problems in perineal care, diaper use, pelvic tilt, difficulty in sitting and pain. Prevention of hip dislocation is necessary. Once hip dislocation happens then management is difficult because of osteoporosis, poor general condition and risk of complications.
Materials and Methods:
Retrospective study of management of hip dislocation in 12 children diagnosed with spastic cerebral palsy. Pre operatively age, GMFCS, acetabular index, migration percentage was noted. All children had unilateral hip dislocation. Open reduction, psoas release,varusderotation osteotomy and Degas acetabular osteotomy was performed in 11 children and only open reduction and VDRO in 1 child. This was followed by hip spica for 3 months. After removal of plaster the child was given an abduction brace and was put on aggressive physiotherapy protocol.
There were 11 children in GMFCS IV and 1 child with GMFCS III. The GMFCS did not improve after surgery. The mean age of surgery was 9 years (7-14 years). Mean followup was 2 years. All patients had migration percentage of >30% on affected side. On the other side the migration percentage was <30%. The mean pre-operative neck shaft angle was 157⁰ (Range 145-160) which decreased to 125⁰ (range 115-130) after surgery. The mean pre- operative acetabular index was 32⁰ (range 30-45) which decreased to 28⁰ (25-30) after surgery. One patient had associated scoliosis and migration percentage increased inspite of scoliosis surgery. A VDRO was performed in this child without pelvic osteotomy. The migration percentage did not worsen in the normal side over the study period, however the pelvic obliquity persisted in 10 children. Progression of osteopenia around the plate was seen in 5 children.One child had fracture below the plate after 9 months of surgery. One child developed bed soar due to plaster.
Successful reduction can be obtained after combined procedure. Prophylactic VDRO of unaffected side should be performed to gain improvement in pelvic tilt. Considering the potential complications and risk factors efforts should be made to prevent hip dislocation by proper monitoring of hip joints during growth.
|How to Cite this Abstract|
|VDRO and Pelvic Osteotomy for Management of Unilateral Hip Dislocation in Spastic CP. International Journal of Conference Proceedings. March 2015;(2015):57|