Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy
Aim Femoral derotation osteotomy (FDO) can be conducted either proximally or distally to correct internal rotation gait (IRG) and increased anteversion in children with cerebral palsy (CP). Previous studies with limited numbers of participants have presented comparable short‐term static and kinemati...
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| Veröffentlicht in: | Developmental medicine and child neurology 2018-10, Vol.60 (10), p.1033-1037 |
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| creator | Niklasch, Mirjam Boyer, Elizabeth R Novacheck, Tom Dreher, Thomas Schwartz, Michael |
| description | Aim
Femoral derotation osteotomy (FDO) can be conducted either proximally or distally to correct internal rotation gait (IRG) and increased anteversion in children with cerebral palsy (CP). Previous studies with limited numbers of participants have presented comparable short‐term static and kinematic outcomes for both techniques. The objective of this retrospective multicentre study was to verify this thesis with a larger number of patients.
Method
In total, 119 children with CP and IRG were included after matching the groups on preoperative mean stance hip rotation: 67 intertrochanteric (proximal group) FDO (average age at surgery 9y [SD 3y]); 52 supracondylar (distal group) FDO (average age at surgery 12y [SD 3y]). One random limb of each child was analyzed. Both transverse plane kinematic gait data and torsional parameters of clinical examination were assessed preoperatively and postoperatively.
Results
On average, both groups’ mean hip rotation and midpoint of hip rotation improved postoperatively, and groups did not differ preoperatively or postoperatively for these variables (p>0.05).
Interpretation
The osteotomy location does not influence short‐term gait kinematics nor static measurements. Therefore, the choice of performing proximal or distal FDO in children with CP for treatment of IRG and increased anteversion should be motivated by considerations other than these outcome parameters.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
Resumen
Osteotomía desrrotadora femoral proximal versus distal en la parálisis cerebral bilateral
Objetivo
La osteotomía desrrotadora femoral (ODF) puede realizarse proximal o distalmente para corregir la marcha intrarrotada y la anteversión femoral, en niños con parálisis cerebral (PC). Los estudios previos con números limitados de participantes presentaron a corto plazo resultados estáticos y cinemáticos comparables en ambas técnicas. El objetivo de este estudio multicéntrico retrospectivo fue verificar esta tesis con un mayor número de pacientes.
Método
En total, se incluyeron 119 niños con PC y marcha intrarrotada (67 intertrocantérica [grupo proximal] ODF [edad promedio en la cirugía 9 años {SD 3 años}; 52 supracondílea [grupo distal] OFD [edad promedio en la cirugía 12 años {SD 3 años}]) después de h |
| doi_str_mv | 10.1111/dmcn.13910 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2035705982</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2035705982</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3650-7cf61a2abde3a889ccce17da27f6af9e89c221fdab6460bcf14bb89b7d0e1fe53</originalsourceid><addsrcrecordid>eNp9kMtOwzAQRS0EoqWw4QNQlggpxXaeXqLylAplAWvLj7EUlMTFToD8PQ4pLJnNnRkdXc1chE4JXpJQl7pR7ZIkjOA9NCdpzuKySNk-mmNMaExySmfoyPs3jHGSZ-khmlFWJEmasDnaPDv7VTWijj7A-d5HuvJdmAw01gXV4Gwnusq2kfUd2M42Q1S1kaxq0cFIKHAgx2Yraj8cowMTFE52ukCvtzcvq_t4vbl7WF2tYxVOwHGhTE4EFVJDIsqSKaWAFFrQwuTCMAgbSonRQuZpjqUyJJWyZLLQGIiBLFmg88l36-x7D77jTeUV1LVowfaeU5xkBc5YSQN6MaHKWe8dGL514WM3cIL5GCAfA-Q_AQb4bOfbywb0H_qbWADIBHxWNQz_WPHrx9XTZPoNhTB9jg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2035705982</pqid></control><display><type>article</type><title>Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Online Library Free Content</source><creator>Niklasch, Mirjam ; Boyer, Elizabeth R ; Novacheck, Tom ; Dreher, Thomas ; Schwartz, Michael</creator><creatorcontrib>Niklasch, Mirjam ; Boyer, Elizabeth R ; Novacheck, Tom ; Dreher, Thomas ; Schwartz, Michael</creatorcontrib><description>Aim
Femoral derotation osteotomy (FDO) can be conducted either proximally or distally to correct internal rotation gait (IRG) and increased anteversion in children with cerebral palsy (CP). Previous studies with limited numbers of participants have presented comparable short‐term static and kinematic outcomes for both techniques. The objective of this retrospective multicentre study was to verify this thesis with a larger number of patients.
Method
In total, 119 children with CP and IRG were included after matching the groups on preoperative mean stance hip rotation: 67 intertrochanteric (proximal group) FDO (average age at surgery 9y [SD 3y]); 52 supracondylar (distal group) FDO (average age at surgery 12y [SD 3y]). One random limb of each child was analyzed. Both transverse plane kinematic gait data and torsional parameters of clinical examination were assessed preoperatively and postoperatively.
Results
On average, both groups’ mean hip rotation and midpoint of hip rotation improved postoperatively, and groups did not differ preoperatively or postoperatively for these variables (p>0.05).
Interpretation
The osteotomy location does not influence short‐term gait kinematics nor static measurements. Therefore, the choice of performing proximal or distal FDO in children with CP for treatment of IRG and increased anteversion should be motivated by considerations other than these outcome parameters.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
Resumen
Osteotomía desrrotadora femoral proximal versus distal en la parálisis cerebral bilateral
Objetivo
La osteotomía desrrotadora femoral (ODF) puede realizarse proximal o distalmente para corregir la marcha intrarrotada y la anteversión femoral, en niños con parálisis cerebral (PC). Los estudios previos con números limitados de participantes presentaron a corto plazo resultados estáticos y cinemáticos comparables en ambas técnicas. El objetivo de este estudio multicéntrico retrospectivo fue verificar esta tesis con un mayor número de pacientes.
Método
En total, se incluyeron 119 niños con PC y marcha intrarrotada (67 intertrocantérica [grupo proximal] ODF [edad promedio en la cirugía 9 años {SD 3 años}; 52 supracondílea [grupo distal] OFD [edad promedio en la cirugía 12 años {SD 3 años}]) después de hacer coincidir los grupos en la rotación de cadera durante el apoyo medio preoperatorio. Se analizó una extremidad aleatoria de cada niño. Tanto los datos de la cinemática en el plano transversal, como los hallazgos del examen clínico de las caderas, se evaluaron preoperatoria y postoperatoriamente.
Resultados
En promedio, la rotación media de cadera y el punto medio de la rotación de cadera de ambos grupos mejoraron en el postoperatorio, y los grupos no difirieron preoperatoria o postoperatoriamente para estas variables (p> 0,05).
Interpretación
La ubicación de la osteotomía no influye en la cinemática de la marcha a corto plazo ni en las mediciones estáticas. Por lo tanto, la elección de realizar OFD proximal o distal en niños con PC para el tratamiento de la marcha intrarrotada y anteversión exagerada debe estar motivada por consideraciones distintas a estos parámetros.
Resumo
Osteotomia de rotação femoral proximal versus distal na paralisia cerebral bilateral
Objetivo
A osteotomia de rotação femoral (ORF) pode ser realizada na região proximal ou distal, com o objetivo de corrigir a rotação interna durante a marcha (RIM) e aumentar a anteversão em crianças com Paralisia Cerebral (PC). Estudos com número limitado de participantes avaliaram medidas estáticas e cinemáticas para comparar as duas técnicas. O objetivo deste estudo retrospectivo multicêntrico foi comparar estas técnicas em um número maior de crianças.
Métodos
119 crianças com PC e RIM foram incluídas no estudo após os grupos apresentarem correspondência na rotação média de quadril durante o apoio. Foram 67 crianças com ORF intertrocantérica [grupo proximal] (idade média: 9 anos, desvio padrão = 3 anos) e 52 crianças com ORF supracondilar [grupo distal] (idade média: 12 anos, desvio padrão = 3 anos). Um membro inferior de cada criança foi avaliado de forma randômica. Uma avaliação cinemática no plano transverso e medidas clínicas de parâmetros rotacionais foram avaliadas antes e após a cirurgia.
Resultados
Em média, a rotação de quadril e o ponto médio de rotação melhoraram após a cirurgia nos dois grupos. Os grupos não apresentaram diferença entre si antes e após a cirurgia (p>0,05).
Interpretação
O local de realização da osteotomia não influencia de forma imediata as medidas cinemáticas e estáticas da marcha. Assim, a escolha de realizar uma técnica proximal ou distal de osteotomia de rotação femoral para corrigir a rotação interna e aumentar a anteversão, em crianças com PC, deve ser motivada por considerações clinicas e não pelas medidas aplicadas no presente estudo.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
This article is commented on by de Morais Filho on pages 971–972 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.</description><identifier>ISSN: 0012-1622</identifier><identifier>EISSN: 1469-8749</identifier><identifier>DOI: 10.1111/dmcn.13910</identifier><identifier>PMID: 29733439</identifier><language>eng</language><publisher>England</publisher><subject>Adolescent ; Biomechanical Phenomena ; Cerebral Palsy - complications ; Cerebral Palsy - surgery ; Child ; Female ; Femur - surgery ; Gait Disorders, Neurologic - etiology ; Gait Disorders, Neurologic - surgery ; Humans ; Male ; Osteotomy - methods ; Outcome Assessment (Health Care) ; Retrospective Studies ; Severity of Illness Index</subject><ispartof>Developmental medicine and child neurology, 2018-10, Vol.60 (10), p.1033-1037</ispartof><rights>2018 Mac Keith Press</rights><rights>2018 Mac Keith Press.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3650-7cf61a2abde3a889ccce17da27f6af9e89c221fdab6460bcf14bb89b7d0e1fe53</citedby><cites>FETCH-LOGICAL-c3650-7cf61a2abde3a889ccce17da27f6af9e89c221fdab6460bcf14bb89b7d0e1fe53</cites><orcidid>0000-0003-3410-816X ; 0000-0002-5448-179X ; 0000-0003-0337-8570</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdmcn.13910$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdmcn.13910$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46387,46811</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29733439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Niklasch, Mirjam</creatorcontrib><creatorcontrib>Boyer, Elizabeth R</creatorcontrib><creatorcontrib>Novacheck, Tom</creatorcontrib><creatorcontrib>Dreher, Thomas</creatorcontrib><creatorcontrib>Schwartz, Michael</creatorcontrib><title>Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy</title><title>Developmental medicine and child neurology</title><addtitle>Dev Med Child Neurol</addtitle><description>Aim
Femoral derotation osteotomy (FDO) can be conducted either proximally or distally to correct internal rotation gait (IRG) and increased anteversion in children with cerebral palsy (CP). Previous studies with limited numbers of participants have presented comparable short‐term static and kinematic outcomes for both techniques. The objective of this retrospective multicentre study was to verify this thesis with a larger number of patients.
Method
In total, 119 children with CP and IRG were included after matching the groups on preoperative mean stance hip rotation: 67 intertrochanteric (proximal group) FDO (average age at surgery 9y [SD 3y]); 52 supracondylar (distal group) FDO (average age at surgery 12y [SD 3y]). One random limb of each child was analyzed. Both transverse plane kinematic gait data and torsional parameters of clinical examination were assessed preoperatively and postoperatively.
Results
On average, both groups’ mean hip rotation and midpoint of hip rotation improved postoperatively, and groups did not differ preoperatively or postoperatively for these variables (p>0.05).
Interpretation
The osteotomy location does not influence short‐term gait kinematics nor static measurements. Therefore, the choice of performing proximal or distal FDO in children with CP for treatment of IRG and increased anteversion should be motivated by considerations other than these outcome parameters.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
Resumen
Osteotomía desrrotadora femoral proximal versus distal en la parálisis cerebral bilateral
Objetivo
La osteotomía desrrotadora femoral (ODF) puede realizarse proximal o distalmente para corregir la marcha intrarrotada y la anteversión femoral, en niños con parálisis cerebral (PC). Los estudios previos con números limitados de participantes presentaron a corto plazo resultados estáticos y cinemáticos comparables en ambas técnicas. El objetivo de este estudio multicéntrico retrospectivo fue verificar esta tesis con un mayor número de pacientes.
Método
En total, se incluyeron 119 niños con PC y marcha intrarrotada (67 intertrocantérica [grupo proximal] ODF [edad promedio en la cirugía 9 años {SD 3 años}; 52 supracondílea [grupo distal] OFD [edad promedio en la cirugía 12 años {SD 3 años}]) después de hacer coincidir los grupos en la rotación de cadera durante el apoyo medio preoperatorio. Se analizó una extremidad aleatoria de cada niño. Tanto los datos de la cinemática en el plano transversal, como los hallazgos del examen clínico de las caderas, se evaluaron preoperatoria y postoperatoriamente.
Resultados
En promedio, la rotación media de cadera y el punto medio de la rotación de cadera de ambos grupos mejoraron en el postoperatorio, y los grupos no difirieron preoperatoria o postoperatoriamente para estas variables (p> 0,05).
Interpretación
La ubicación de la osteotomía no influye en la cinemática de la marcha a corto plazo ni en las mediciones estáticas. Por lo tanto, la elección de realizar OFD proximal o distal en niños con PC para el tratamiento de la marcha intrarrotada y anteversión exagerada debe estar motivada por consideraciones distintas a estos parámetros.
Resumo
Osteotomia de rotação femoral proximal versus distal na paralisia cerebral bilateral
Objetivo
A osteotomia de rotação femoral (ORF) pode ser realizada na região proximal ou distal, com o objetivo de corrigir a rotação interna durante a marcha (RIM) e aumentar a anteversão em crianças com Paralisia Cerebral (PC). Estudos com número limitado de participantes avaliaram medidas estáticas e cinemáticas para comparar as duas técnicas. O objetivo deste estudo retrospectivo multicêntrico foi comparar estas técnicas em um número maior de crianças.
Métodos
119 crianças com PC e RIM foram incluídas no estudo após os grupos apresentarem correspondência na rotação média de quadril durante o apoio. Foram 67 crianças com ORF intertrocantérica [grupo proximal] (idade média: 9 anos, desvio padrão = 3 anos) e 52 crianças com ORF supracondilar [grupo distal] (idade média: 12 anos, desvio padrão = 3 anos). Um membro inferior de cada criança foi avaliado de forma randômica. Uma avaliação cinemática no plano transverso e medidas clínicas de parâmetros rotacionais foram avaliadas antes e após a cirurgia.
Resultados
Em média, a rotação de quadril e o ponto médio de rotação melhoraram após a cirurgia nos dois grupos. Os grupos não apresentaram diferença entre si antes e após a cirurgia (p>0,05).
Interpretação
O local de realização da osteotomia não influencia de forma imediata as medidas cinemáticas e estáticas da marcha. Assim, a escolha de realizar uma técnica proximal ou distal de osteotomia de rotação femoral para corrigir a rotação interna e aumentar a anteversão, em crianças com PC, deve ser motivada por considerações clinicas e não pelas medidas aplicadas no presente estudo.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
This article is commented on by de Morais Filho on pages 971–972 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.</description><subject>Adolescent</subject><subject>Biomechanical Phenomena</subject><subject>Cerebral Palsy - complications</subject><subject>Cerebral Palsy - surgery</subject><subject>Child</subject><subject>Female</subject><subject>Femur - surgery</subject><subject>Gait Disorders, Neurologic - etiology</subject><subject>Gait Disorders, Neurologic - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Osteotomy - methods</subject><subject>Outcome Assessment (Health Care)</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><issn>0012-1622</issn><issn>1469-8749</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EoqWw4QNQlggpxXaeXqLylAplAWvLj7EUlMTFToD8PQ4pLJnNnRkdXc1chE4JXpJQl7pR7ZIkjOA9NCdpzuKySNk-mmNMaExySmfoyPs3jHGSZ-khmlFWJEmasDnaPDv7VTWijj7A-d5HuvJdmAw01gXV4Gwnusq2kfUd2M42Q1S1kaxq0cFIKHAgx2Yraj8cowMTFE52ukCvtzcvq_t4vbl7WF2tYxVOwHGhTE4EFVJDIsqSKaWAFFrQwuTCMAgbSonRQuZpjqUyJJWyZLLQGIiBLFmg88l36-x7D77jTeUV1LVowfaeU5xkBc5YSQN6MaHKWe8dGL514WM3cIL5GCAfA-Q_AQb4bOfbywb0H_qbWADIBHxWNQz_WPHrx9XTZPoNhTB9jg</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Niklasch, Mirjam</creator><creator>Boyer, Elizabeth R</creator><creator>Novacheck, Tom</creator><creator>Dreher, Thomas</creator><creator>Schwartz, Michael</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3410-816X</orcidid><orcidid>https://orcid.org/0000-0002-5448-179X</orcidid><orcidid>https://orcid.org/0000-0003-0337-8570</orcidid></search><sort><creationdate>201810</creationdate><title>Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy</title><author>Niklasch, Mirjam ; Boyer, Elizabeth R ; Novacheck, Tom ; Dreher, Thomas ; Schwartz, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3650-7cf61a2abde3a889ccce17da27f6af9e89c221fdab6460bcf14bb89b7d0e1fe53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Biomechanical Phenomena</topic><topic>Cerebral Palsy - complications</topic><topic>Cerebral Palsy - surgery</topic><topic>Child</topic><topic>Female</topic><topic>Femur - surgery</topic><topic>Gait Disorders, Neurologic - etiology</topic><topic>Gait Disorders, Neurologic - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Osteotomy - methods</topic><topic>Outcome Assessment (Health Care)</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Niklasch, Mirjam</creatorcontrib><creatorcontrib>Boyer, Elizabeth R</creatorcontrib><creatorcontrib>Novacheck, Tom</creatorcontrib><creatorcontrib>Dreher, Thomas</creatorcontrib><creatorcontrib>Schwartz, Michael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Developmental medicine and child neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Niklasch, Mirjam</au><au>Boyer, Elizabeth R</au><au>Novacheck, Tom</au><au>Dreher, Thomas</au><au>Schwartz, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy</atitle><jtitle>Developmental medicine and child neurology</jtitle><addtitle>Dev Med Child Neurol</addtitle><date>2018-10</date><risdate>2018</risdate><volume>60</volume><issue>10</issue><spage>1033</spage><epage>1037</epage><pages>1033-1037</pages><issn>0012-1622</issn><eissn>1469-8749</eissn><abstract>Aim
Femoral derotation osteotomy (FDO) can be conducted either proximally or distally to correct internal rotation gait (IRG) and increased anteversion in children with cerebral palsy (CP). Previous studies with limited numbers of participants have presented comparable short‐term static and kinematic outcomes for both techniques. The objective of this retrospective multicentre study was to verify this thesis with a larger number of patients.
Method
In total, 119 children with CP and IRG were included after matching the groups on preoperative mean stance hip rotation: 67 intertrochanteric (proximal group) FDO (average age at surgery 9y [SD 3y]); 52 supracondylar (distal group) FDO (average age at surgery 12y [SD 3y]). One random limb of each child was analyzed. Both transverse plane kinematic gait data and torsional parameters of clinical examination were assessed preoperatively and postoperatively.
Results
On average, both groups’ mean hip rotation and midpoint of hip rotation improved postoperatively, and groups did not differ preoperatively or postoperatively for these variables (p>0.05).
Interpretation
The osteotomy location does not influence short‐term gait kinematics nor static measurements. Therefore, the choice of performing proximal or distal FDO in children with CP for treatment of IRG and increased anteversion should be motivated by considerations other than these outcome parameters.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
Resumen
Osteotomía desrrotadora femoral proximal versus distal en la parálisis cerebral bilateral
Objetivo
La osteotomía desrrotadora femoral (ODF) puede realizarse proximal o distalmente para corregir la marcha intrarrotada y la anteversión femoral, en niños con parálisis cerebral (PC). Los estudios previos con números limitados de participantes presentaron a corto plazo resultados estáticos y cinemáticos comparables en ambas técnicas. El objetivo de este estudio multicéntrico retrospectivo fue verificar esta tesis con un mayor número de pacientes.
Método
En total, se incluyeron 119 niños con PC y marcha intrarrotada (67 intertrocantérica [grupo proximal] ODF [edad promedio en la cirugía 9 años {SD 3 años}; 52 supracondílea [grupo distal] OFD [edad promedio en la cirugía 12 años {SD 3 años}]) después de hacer coincidir los grupos en la rotación de cadera durante el apoyo medio preoperatorio. Se analizó una extremidad aleatoria de cada niño. Tanto los datos de la cinemática en el plano transversal, como los hallazgos del examen clínico de las caderas, se evaluaron preoperatoria y postoperatoriamente.
Resultados
En promedio, la rotación media de cadera y el punto medio de la rotación de cadera de ambos grupos mejoraron en el postoperatorio, y los grupos no difirieron preoperatoria o postoperatoriamente para estas variables (p> 0,05).
Interpretación
La ubicación de la osteotomía no influye en la cinemática de la marcha a corto plazo ni en las mediciones estáticas. Por lo tanto, la elección de realizar OFD proximal o distal en niños con PC para el tratamiento de la marcha intrarrotada y anteversión exagerada debe estar motivada por consideraciones distintas a estos parámetros.
Resumo
Osteotomia de rotação femoral proximal versus distal na paralisia cerebral bilateral
Objetivo
A osteotomia de rotação femoral (ORF) pode ser realizada na região proximal ou distal, com o objetivo de corrigir a rotação interna durante a marcha (RIM) e aumentar a anteversão em crianças com Paralisia Cerebral (PC). Estudos com número limitado de participantes avaliaram medidas estáticas e cinemáticas para comparar as duas técnicas. O objetivo deste estudo retrospectivo multicêntrico foi comparar estas técnicas em um número maior de crianças.
Métodos
119 crianças com PC e RIM foram incluídas no estudo após os grupos apresentarem correspondência na rotação média de quadril durante o apoio. Foram 67 crianças com ORF intertrocantérica [grupo proximal] (idade média: 9 anos, desvio padrão = 3 anos) e 52 crianças com ORF supracondilar [grupo distal] (idade média: 12 anos, desvio padrão = 3 anos). Um membro inferior de cada criança foi avaliado de forma randômica. Uma avaliação cinemática no plano transverso e medidas clínicas de parâmetros rotacionais foram avaliadas antes e após a cirurgia.
Resultados
Em média, a rotação de quadril e o ponto médio de rotação melhoraram após a cirurgia nos dois grupos. Os grupos não apresentaram diferença entre si antes e após a cirurgia (p>0,05).
Interpretação
O local de realização da osteotomia não influencia de forma imediata as medidas cinemáticas e estáticas da marcha. Assim, a escolha de realizar uma técnica proximal ou distal de osteotomia de rotação femoral para corrigir a rotação interna e aumentar a anteversão, em crianças com PC, deve ser motivada por considerações clinicas e não pelas medidas aplicadas no presente estudo.
What this paper adds
Femoral derotation osteotomy (FDO) location does not influence mean stance hip rotation in cerebral palsy (CP).
FDO location does not influence mid‐point hip rotation in CP.
FDO location should be motivated by concomitant procedures performed.
This article is commented on by de Morais Filho on pages 971–972 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.</abstract><cop>England</cop><pmid>29733439</pmid><doi>10.1111/dmcn.13910</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0003-3410-816X</orcidid><orcidid>https://orcid.org/0000-0002-5448-179X</orcidid><orcidid>https://orcid.org/0000-0003-0337-8570</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-1622 |
| ispartof | Developmental medicine and child neurology, 2018-10, Vol.60 (10), p.1033-1037 |
| issn | 0012-1622 1469-8749 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2035705982 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content |
| subjects | Adolescent Biomechanical Phenomena Cerebral Palsy - complications Cerebral Palsy - surgery Child Female Femur - surgery Gait Disorders, Neurologic - etiology Gait Disorders, Neurologic - surgery Humans Male Osteotomy - methods Outcome Assessment (Health Care) Retrospective Studies Severity of Illness Index |
| title | Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T03%3A10%3A05IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Proximal%20versus%20distal%20femoral%20derotation%20osteotomy%20in%20bilateral%20cerebral%20palsy&rft.jtitle=Developmental%20medicine%20and%20child%20neurology&rft.au=Niklasch,%20Mirjam&rft.date=2018-10&rft.volume=60&rft.issue=10&rft.spage=1033&rft.epage=1037&rft.pages=1033-1037&rft.issn=0012-1622&rft.eissn=1469-8749&rft_id=info:doi/10.1111/dmcn.13910&rft_dat=%3Cproquest_cross%3E2035705982%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2035705982&rft_id=info:pmid/29733439&rfr_iscdi=true |