OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V) older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra) and valgus proximal osteotomy of the femur (VPOF) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips) or VPOF (14 patients, 23 hips) were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints) and VPOF – in 14 patients (23 joints). Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices

Analysis of kinematic and kinetic parameters of pace in cerebral palsy patients with internal torsion hip deformity

Literature data on the correlation between femoral torsion during clinical examination and during walking are different. Aim of the study was to compare kinetics and kinematics in cerebral palsy patients with iatrogenic crouch gait pattern with and without clinically diagnosed internal femoral torsion. Material and methods. Comparative analysis of clinical examination and three-dimensional gait analysis (3DGA) was performed in 61 subjects (122 limbs), GMFCS II with iatrogenic crouch gait pattern. The average age was 14.5 ± 2.5 years. This sample was formed in 2018–2021. Kinetic and kinematic data were recorded by Qualisys 7+ optical cameras (8 cameras) with passive marker video capture technology, synchronized with six KISTLER dyno platforms (Switzerland). The analysis was performed in the QTM (Qualisys) and Visual3D (C-Motion) programs with automated calculation of values. Based on the clinical data, all the patients were divided as follows: I – no clinically detected internal femoral torsion – 50 limbs, II – clinically detected internal femoral torsion – 68 limbs. Results. Comparison of the values of kinematics and kinetics in groups of patients according to the criterion of clinically detected/not detected had statistically significant differences in kinematics – the maximum and minimum values of femur and tibia torsion relative to the norm. Differential diagnosis of compensated/decompensated internal femoral torsion was represented by multidirectional values of the angle of foot positioning relative to the motion vector. The kinetic parameters in the groups were statistically doubtful, because they depended on the walking speed of patients, their ability to move. Conclusions. The values of maximum femoral torsion angle up to 22° were not clinically interpreted as internal femoral torsion, those from 22° to 28° can be interpreted both with clinically revealed femoral torsion (68 %) and with the absence of femoral torsion (22 %), which corresponds to the risk group, those more than 28° fell into the group of clinically diagnosed internal femoral torsion

Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

The aim of the study is to evaluate the efficiency of triple arthrodesis of foot and its effect on soft tissues blood supply at the surgical site during simultaneous correction of segment deformity in patients with cerebral palsy.Material and Methods. The present study reflects the authors’ experience of triple arthrodesis for correction and stabilization of foot multicomponent deformities of varying severity in 75 patients (136 feet) with cerebral palsy (IIIV level by Gross Motor Function Classification System (GMFCS)) treated in the Ilizarov center in the period from April 2012 to December 2016. The average age of the patients was 16.4±4.3 years (from 11 years 8 months to 43 years 3 months). All patients included into the study had severe arthrosis of hind and midfoot. The main option of foot fixation in this group of patients was internal fixation (elastic threaded wires, compression screws) together with plaster cast immobilization for 6–8 weeks. All patients underwent average of 4.59 surgical elements during a procedure as part of simultaneous multilevel interventions. The blood supply at the surgical site was evaluated by laser and high-frequency Doppler flowmetry before and after all stages of the surgery.Results. Long-term outcomes were evaluated at the average of 19 months after the surgery in 56 (74.7%) patients. 37 patients (66.1%) demonstrated good treatment outcomes and 19 patients (33.9%) — satisfactory outcomes. No unsatisfactory outcomes were observed. The clinical outcome of foot surgery was evaluated using the Angus-Cowell criteria. The obtained significant x-ray enhancement was maintained at the control stages of the follow up. Despite large simultaneous correction of foot deformity, there was no decrease in the parameters of microcirculatory blood supply of the skin, muscles and subcutaneous fat of the foot. The authors observed a stabilized or an increased perfusion of soft tissues.Conclusion. Triple arthrodesis for correction of foot deformities in patients with cerebral palsy and severe arthrosis in hind and midfoot is an efficient method which allows to correct and stabilize gained position of segments. The data of physiological research testify the sparing approach of such procedure and a possibility of an earlier weight-bearing on operated limb