scholarly journals The unstable hip in children with cerebral palsy: does an acetabuloplasty add midterm stability?

2021 ◽  
pp. 1-7
Author(s):  
Matthias W. Axt ◽  
Danielle L. Wadley
Keyword(s):  
Cerebral Palsy ◽  
Classification System ◽  
Group Versus ◽  
Level Of Evidence ◽  
Hip Stability ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Outcome Difference ◽  
Retrospective Comparative Study

Purpose This study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP). Methods All patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases. Results In total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004). Conclusion Reconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO. Level of Evidence Level III, retrospective comparative study

Cerebral Palsy in Children With Congenital Zika Syndrome: A 2-Year Neurodevelopmental Follow-up

2019 ◽  
Vol 35 (3) ◽  
pp. 202-207 ◽  
Author(s):  
Alessandra Lemos de Carvalho ◽  
Paloma Ventura ◽  
Tânia Taguchi ◽  
Ivar Brandi ◽  
Carlos Brites ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Neurological Examination ◽  
Head Circumference ◽  
Classification System ◽  
Test Scores ◽  
Examination Score ◽  
Children With Cerebral Palsy ◽  
Toddler Development

Objective: To describe the 2-year neurodevelopmental outcome in children with cerebral palsy associated with congenital Zika (CZ) and explore variables associated with a more severe presentation. Methods: Data on 69 children with cerebral palsy associated with CZ, followed in a neurorehabilitation hospital, who consecutively attended the neurodevelopmental assessment at 2 years of age, were collected. Bayley III Scales of Infant and Toddler Development, Hammersmith Infant Neurological Examination, and Gross Motor Function Classification System were used for the outcome evaluation. Descriptive and inferential statistical analysis were performed. Results: The median age at follow-up was of 24.0 (23-32) months. Only 3 (4.3%) children were not microcephalic. The majority presented with bilateral (94.2%), spastic (100.0%), Gross Motor Function Classification System grade IV or V (92.8%) cerebral palsy, epilepsy (73.1%), extremely low performances on cognitive (94.2%), language (95.7%), and motor (95.7%) Bayley-III Scales of Infant and Toddler Development Test scores. The median Hammersmith Infant Neurological Examination score was of 21.0 (range 9-75). There was a correlation between birth head circumference with the cognitive ( r = 0.3, P < .01), language ( r = 0.3, P < .01), and motor ( r = 0.3, P < .01) Bayley-III Scales of Infant and Toddler Development Test scores, as well as with the Hammersmith Infant Neurological Examination score ( r = 0.2, P < .03). An association was observed between an inferior median Hammersmith Infant Neurological Examination score with congenital microcephaly ( P = .04), arthrogryposis ( P = .02), and epilepsy in the first year ( P < .01). Conclusion: Cerebral palsy related to CZ presents with a severe global impairment at a 2-year follow-up. Birth head circumference, arthrogryposis, and early epilepsy are associated with a worse outcome and may be considered as prognostic markers. These findings are important for the neurorehabilitation planning, parents’ guiding, and future prognostic studies.

scholarly journals Hip displacement in children with cerebral palsy in Scotland: a total population study

2018 ◽  
Vol 12 (6) ◽  
pp. 635-639 ◽  
Author(s):  
K. E. Bugler ◽  
M. S. Gaston ◽  
J. E. Robb
Keyword(s):  
Cerebral Palsy ◽  
Total Population ◽  
Hip Dislocation ◽  
Level Of Evidence ◽  
Surveillance Programme ◽  
Hip Displacement ◽  
Number Of Children ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Gmfcs Level

Purpose The purpose of this study is to report the number of children from a total population of children with cerebral palsy (CP) in Scotland who had a displaced or dislocated hip at first registration in a national surveillance programme. Methods Migration percentage (MP), laterality, Gross Motor Function Classification System (GMFCS) level, CP subtype, distribution of CP and age were analyzed in 1171 children. Relative risk was calculated with 95% confidence intervals. Hip displacement and dislocation were defined as a MP of 40 to 99 and > 100 respectively. Results Radiographs were available from the first assessment of 1171 children out of 1933 children registered on the system. In all, 2.5% of children had either one or both hips dislocated (29/1171) and dislocation only occurred in children of GMFCS levels IV and V. A total of 10% of children had a MP 40 to 99 in one or both hips (117/1171). An increasing GMFCS level was strongly associated with an abnormal MP. Hip dislocation was unusual in patients under the age of seven years. A MP of 40 to 99 was not seen in children with isolated dystonia. Displacement was more frequent in children with bilateral involvement and dislocation was only seen in spastic and mixed tone groups. Conclusion This data gives an overview of the number of CP children who have hip displacement/dislocation in Scotland and who will possibly require surgery. Level of Evidence I

Associations among the Degree of Hip Adductor Spasticity, the Level of Gross Motor Function Classification System (GMFCS) and the Migration Percentage in Children with Cerebral Palsy

2016 ◽  
Vol 5 (01) ◽  
pp. 11-21
Author(s):  
Lindrawati Tjuatja ◽  
Luh Karunia Wahyuni ◽  
Aryadi Kurniawan ◽  
Damayanti Sekarsari ◽  
Hamzah Shatri
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Classification System ◽  
Plain Radiograph ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Insignificant Difference ◽  
Modified Tardieu Scale

Objectives : This study was aimed at detecting the occurrence of hip dislocation in children with cerebral palsy (CP) by seeking the association among the degree of hip adductor spasticity, level of Gross MotorFunction Classification System (GMFCS) and Migration Percentage (MP).Methods : It was a cross sectional study with inclusion criterias were children with cerebral palsy, both male and female aged 2-10 years old, and parent’s approval by signing informed consent. Exclusion criterias werecomorbidities of other neuromotor impairments, such as spina bifida; other neuromuscular or musculoskeletal diseases, etc; uncooperative; and presenting severe diseases at the day of assessment. Measurement methodsincluded the Modified Tardieu Scale (MTS) R2, R1 and R2-R1 components to measure hip adductor spasticity; Gross Motor Function Classification System (GMFCS) protocol to assess gross motor ability; andAnterior-Posterior (AP) pelvic plain radiograph to calculate the Migration Percentage (MP) value.Results : At the initial phase, 31 children were included, however only 57 legs were analyzed for hip adductor spasticity and MP. There were no correlation between the degree of hip adductor spasticity and MPboth the R2 with MP (r = -0.060; p = 0.658), and R1 with MP (r = -0.136; p = 0.314). Moreover, there was insignificant difference between level of GMFCS and MP (p = 0.831).Conclusion : This study indicates nill correlation between the degree of hip adductor spasticity and the MP, and insignificant difference between the level of GMFCS and MP to detect the occurence of hip dislocationin children with cerebral palsy.Keywords : Modified Tardieu Scale, R2, R1, level of GMFCS, AP pelvic plain radiograph, MP value.

scholarly journals Reliability and efficiency of three methods of calculating migration percentage on radiographs for hip surveillance in children with cerebral palsy

2018 ◽  
Vol 12 (2) ◽  
pp. 145-151 ◽  
Author(s):  
V. A. Kulkarni ◽  
J. R. Davids ◽  
A. D. Boyles ◽  
N. Q. Cung ◽  
A. Bagley
Keyword(s):  
Cerebral Palsy ◽  
Absolute Difference ◽  
Measurement Tool ◽  
Digital Measurement ◽  
Level Of Evidence ◽  
Digital Templating ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
The Mean ◽  
Time Required

Purpose Hip surveillance programmes for children with cerebral palsy (CP) utilize the migration percentage (MP) measurement to initiate referrals and recommend treatment. This study assesses the reliability and efficiency of three methods of MP measurement on anteroposterior (AP) pelvis radiographs. Methods A total of 20 AP pelvis radiographs (40 hips) of children with CP were measured by three raters on two occasions using three methods: digital measurement (DM) on a Picture Archiving and Communication System monitor, computer-aided measurement (CA) using a digital templating tool and mobile device application measurement (MA) using a freely available MP measurement tool. For each method, the time required to complete the MP measurement of both hips on each AP pelvis radiograph was measured. Intra-class correlation coefficient (ICC) was used to determine reliability, and analysis of variance was used to compare groups. Results All three methods of determining MP showed excellent inter-rater and intra-rater reliability (ICC 0.976 to 0.989). The mean absolute difference in MP measurement was not significant between trials for a single rater (DM 2.8%, CA 1.9%, MA 2.2%) or between raters (DM 3.6%, CA 2.9%, MA 3.6%). The mean time to complete MP measurement was significantly different between methods, with DM = 151 seconds, CA = 73 seconds and MA = 80 seconds. Conclusion All three MP measurement methods were highly reliable with clinically acceptable measurement error. The time required to measure a hip surveillance radiograph can be reduced by approximately 50% by utilizing a computer-based or mobile application-based MP measurement tool. Level of Evidence III

scholarly journals Combined pelvic and femoral reconstruction in children with cerebral palsy

2017 ◽  
Vol 46 (1) ◽  
pp. 475-484 ◽  
Author(s):  
Nabil Alassaf ◽  
Neil Saran ◽  
Theirry Benaroch ◽  
Reggie Cherine Hamdy
Keyword(s):  
Cerebral Palsy ◽  
Migration Index ◽  
Radiographic Outcomes ◽  
Hip Stability ◽  
Derotational Osteotomy ◽  
Children With Cerebral Palsy ◽  
Cohort Study Design ◽  
The Mean ◽  
Femoral Reconstruction

Objective The primary aim of this study was to determine the effect of age, femoral head migration, and ambulatory status on radiographic outcomes after combined pelvic and femoral reconstruction in children with cerebral palsy. The secondary aim was to evaluate the fate of the opposite hip after unilateral reconstruction. Methods A retrospective cohort study design of consecutive patients from 1995–2009 was used. The records were screened for patients who underwent varus derotational osteotomy and modified Dega osteotomy. Results Eighty-five hips in 71 patients were included. The mean age was 8.4 ± 3.2 years and the mean follow-up was 6.6 ± 3.1 years. The final measures were a mean migration index of 20% ± 15.58%, centre edge angle of 28.45° ± 15.98°, and Sharp’s angle of 40.75° ± 8.5°. Those values were not correlated with age and the initial migration index. Nonambulatory status did not negatively affect hip stability. Final measurements of the contralateral hips were similar to the reconstructed hips, and the cumulative incidence for later reconstruction was 5.67%. Conclusions Regardless of age, preoperative displacement, and ambulation, the combined procedure provides durable radiographic improvement. In unilateral cases, there is a low risk of later deterioration of the opposite side.

scholarly journals Is the Gothic Arch a reliable radiographic landmark for migration percentage in children with cerebral palsy?

2020 ◽  
Vol 14 (5) ◽  
pp. 397-404
Author(s):  
Caesar Wek ◽  
Piyal Chowdhury ◽  
Christian Smith ◽  
Michail Kokkinakis
Keyword(s):  
Cerebral Palsy ◽  
Acetabular Dysplasia ◽  
Classical Method ◽  
Level Of Evidence ◽  
Observer Reliability ◽  
Modified Method ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Hip Migration ◽  
Gothic Arch

Introduction Reimers migration percentage (MP) is the gold standard for measuring hip displacement in children with cerebral palsy (CP). Hip surveillance registries proposed using the top of the Gothic arch (GA) as a modification in patients with acetabular dysplasia because the classical method (CM) described by Reimers may underestimate hip migration. The aim of this study is to assess the inter- and intra-observer reliability of the modified method (MM) versus the CM and identify their effect on the MP. Methods We performed a retrospective review of 50 children with CP, who had a hip radiograph at our institution between 1st April 2014 and 28th February 2018. All hip radiographs were carefully selected to show the presence of a GA. Four observers measured the MP using the CM and MM for each patient. Interclass coefficient was used to estimate inter- and intra-observer reliability. Results Inter-observer reliability was excellent for the CM with ICC 0.96 (95% CI 0.94 to 0.97) and good for the MM, ICC 0.78 (95% CI 0.51 to 0.89) p < 0.001. Intra-observer reliability was excellent for both methods raging from ICC 0.94 to 0.99 for the CM and ICC 0.89 to 0.95 for the MM. The mean MP was 19% for the CM and 28% for the MM (p < 0.001). Conclusion The CM is more reliable than the MM to measure hip migration in children with CP. If the CM is used and acetabular dysplasia with a GA are present on the hip radiograph, then a 9% hip migration underestimation should be considered on decisions for both referral and surgical management. Level of evidence II

scholarly journals Prophylactic antibiotics in soft-tissue procedures in children with cerebral palsy

2018 ◽  
Vol 12 (3) ◽  
pp. 279-281
Author(s):  
L. R. Perotti ◽  
O. Abousamra ◽  
K. J. Rogers ◽  
F. Miller ◽  
J. P. Sees
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Surgical Site Infections ◽  
Paediatric Population ◽  
Prophylactic Antibiotics ◽  
Level Of Evidence ◽  
Children With Cerebral Palsy ◽  
Antibiotic Group ◽  
Therapeutic Study

Purpose Data on the benefits of perioperative prophylactic antibiotics in the paediatric population are lacking. In this study, we aimed to assess the rate of infection after isolated soft-tissue procedures in patients with cerebral palsy with and without preoperative prophylactic antibiotics between 2009 and 2015. Methods We reviewed the records of all children with cerebral palsy who underwent isolated soft-tissue procedures (on the upper and lower limb) at our hospital between 2009 and 2015. Children with at least 30-day postoperative follow-up were included. Children who had groin incisions were excluded. Results Two groups were identified: the antibiotic group (77 children with 203 incisions and 343 procedures) had one surgical site infection; the no-antibiotic group (48 children with 102 incisions and 177 procedures) had no surgical site infections. Conclusion These results suggest that the use of preoperative antibiotics does not change the rate of postoperative surgical site infections. Level of Evidence Level III therapeutic study

scholarly journals Hip displacement in children with cerebral palsy

2021 ◽  
Vol 103-B (2) ◽  
pp. 411-414
Author(s):  
Sarah J. Wordie ◽  
Kate E. Bugler ◽  
Paul R. Bessell ◽  
James E. Robb ◽  
Mark S. Gaston
Keyword(s):  
Cerebral Palsy ◽  
Large Population ◽  
Population Based ◽  
Population Based Study ◽  
Pelvic Radiographs ◽  
Children With Cerebral Palsy ◽  
Degree Of Certainty ◽  
Migration Percentage ◽  
Integrated Pathway

Aims The migration percentage (MP) is one criterion used for surgery in dislocated or displaced hips in children with cerebral palsy (CP). The MP at which a displaced hip can no longer return to normal is unclear. The aim of this paper was to identify the point of no return of the MP through a large population-based study. Methods All children registered on the Cerebral Palsy Integrated Pathway Scotland surveillance programme undergo regular pelvic radiographs. Any child who had a MP measuring over 35% since the programme’s inception in 2013, in at least one hip and at one timepoint, was identified. The national radiography database was then interrogated to identify all pelvic radiographs for each of these children from birth through to the date of analysis. A minimum of a further two available radiographs following the initial measurement of MP ≥ 35% was required for inclusion. Results A total of 239 children (346 hips) were identified as suitable for analysis at a mean of 6.5 years (2.0 to 14.8) follow-up. In all, 1,485 radiographs taken both prior to and after a hip had a MP ≥ 35% were examined and the MP measured to identify any progression of displacement. Interrogation of the data identified that hips with a MP up to 46% returned to a MP below 40% without intervention, and all hips with a MP equal to or greater than 46% displaced further and the MP did not return to the normal range. Statistical analysis showed the result to be 98% specific with this degree of certainty that hips reaching a MP ≥ 46% would not spontaneously regress. Conclusion These findings are clinically relevant in showing that it may be reasonable to continue to monitor hips with a MP not exceeding 46%. This threshold will also guide referral for further management of a displacing hip. Cite this article: Bone Joint J 2021;103-B(2):411–414.

Pronator teres selective neurectomy in children with cerebral palsy

2018 ◽  
Vol 43 (8) ◽  
pp. 879-884 ◽  
Author(s):  
Marion Helin ◽  
Manon Bachy ◽  
Claire Stanchina ◽  
Frank Fitoussi
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin Injection ◽  
Hand Function ◽  
Global Strategy ◽  
Level Of Evidence ◽  
Pronator Teres ◽  
Upper Limb Function ◽  
Children With Cerebral Palsy ◽  
Selective Neurectomy

The objective of this study was to evaluate the results after selective pronator teres (PT) neurectomy in children with spastic hemiplegia. Patients with PT spasticity without contracture and an active supination improvement after PT botulinum toxin injection were included. Hand function and deformities were evaluated with the House score, Gschwind and Tonkin pronation deformity classification and Zancolli’s classification. Twenty-two patients (mean age 11.6 years) were included in this study. The average follow-up was 32.6 months. All but one patient improved their supination with a preoperative mean active supination of 5° (range −80–70°) and postoperative of 48° (range 10–90°). Active pronation was always maintained at the last follow-up. PT selective neurectomy appears to improve active and passive forearm supination and should be included in a global strategy of treatments to improve upper limb function in children with cerebral palsy. Level of evidence: IV

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