NDLI: Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: uni- or bilateral femoral derotation osteotomy?

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Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: uni- or bilateral femoral derotation osteotomy?

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Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: uni- or bilateral femoral derotation osteotomy?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Niklasch, M. Döderlein, L. Klotz, M. C. Braatz, F. Wolf, S. I. Dreher, T.
Description	Country affiliation: Germany Author Affiliation: Niklasch M ( Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.); Döderlein L ( Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany.); Klotz MC ( Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.); Braatz F ( Klinik für Unfallchirurgie und Orthopädie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.); Wolf SI ( Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.); Dreher T ( Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany. Electronic address: thomas.dreher@med.uni-heidelberg.de.)
Abstract	Internal rotation gait is common among children with bilateral cerebral palsy. However, despite bilaterally increased femoral anteversion asymmetric internal rotation gait is often found. Femoral derotation osteotomy (FDO) is commonly performed bilaterally. Variable functional outcomes are reported especially in cases with mild internal hip rotation during gait and abnormal preoperative pelvic rotation. A major question is if a unilateral treatment of the more involved side in asymmetric cases leads to a comparable or even superior outcome. One hundred and nine children with spastic bilateral CP treated with FDO with pre- and 1-year postoperative 3D gait analysis were retrospectively collected. The asymmetry was calculated from the preoperative difference between both limbs in hip rotation obtained by 3D gait analysis. Twenty-eight children with asymmetry larger than 20° were selected and classified into two groups, according to whether they obtained a unilateral or bilateral FDO. Preoperative clinical examination and pre- and postoperative hip and pelvic rotation in gait analysis on the more and the less involved side did not differ significantly between both groups. Interestingly, in both groups, hip rotation did not change significantly in less-involved limbs, although intraoperative derotation averaged 25°. After unilateral FDO a significant change in pelvic rotation resulted, whereas this was not found after bilateral FDO. The results of this study suggest that unilateral FDO in children with asymmetric internal rotation gait leads to a comparable functional outcome compared to bilateral treatment. Furthermore, it was shown for the first time that considering the asymmetry has a positive effect on pelvic rotation.
File Format	HTM / HTML
ISSN	09666362
Issue Number	2
Volume Number	41
e-ISSN	18792219
Journal	Gait & Posture
Language	English
Publisher	Elsevier
Publisher Date	2015-02-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Femur Gait Osteotomy Humans Child, Preschool Male Gait Disorders, Neurologic Pelvis Journal Article Time Factors Etiology Surgery Female Physiology Retrospective Studies Child Complications Postoperative Period Treatment Outcome Rotation Physiopathology Follow-up Studies Adolescent Cerebral Palsy Methods
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Rehabilitation Biophysics Sports Science

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