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Cerebral palsy tenotomy

L Phillips, K Hesketh, E K Schaeffer, J Andrade, J Farr, K Mulpuri
PURPOSE: Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. METHODS: A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013...
October 1, 2017: Journal of Children's Orthopaedics
Terje Terjesen
Background and purpose - Hip displacement is frequent in nonambulatory children with cerebral palsy (CP) and treatment is controversial. This prospective study assesses the effectiveness of soft-tissue releases to treat hip subluxation, analyses prognostic factors for outcome, and identifies time to failure in hips with poor outcome. Patients and methods - 37 children (16 girls) with hip subluxation were recruited from the population-based screening program for children with CP in Norway. They had consecutively undergone soft-tissue releases (bilateral tenotomies of adductors and iliopsoas) at a mean age of 5...
December 2017: Acta Orthopaedica
García Luis-Alejandro, Gómez Bárbara
BACKGROUND: Spastic thumb deformity in cerebral palsy significantly impedes hand function. Flexion-adduction forces across the first ray is the result from imbalance between intrinsic and extrinsic muscles. Multiples surgeries have been devised for the treatment of this condition such as contracture release and by tendon transfers for balancing the muscles forces. We report the results of a less demanding surgical technique, intended to avoid hyperextension of the metacarpophalangeal joint previously described in other series...
September 2017: Journal of Hand Surgery Asian-Pacific Volume
Philippe Hernigou, Nicolas Gravina, Damien Potage, Arnaud Dubory
Clubfoot is one of the most common congenital orthopaedic anomalies and was described by Hippocrates in the year 400 BC. From manipulation in antiquity to splint and plaster in the Renaissance the treatment had improved before tenotomy. Tenotomy was tested during the 19th century and will be explained in this manuscript; the introduction of subcutaneous tenotomy of the Achilles tendon had focused the attention of surgeons on the surgical treatment of clubfeet. While this operation was very successful in the correction of equinus deformities due to poliomyelitis, cerebral palsy, and old injuries, it was not a panacea for the patient with the congenital clubfoot...
October 2017: International Orthopaedics
Peter Buxbom, Stig Sonne-Holm, Niels Ellitsgaard, Christian Wong
Background and purpose - Studies have indicated that one-third of children with cerebral palsy (CP) develop dislocation of the hip that needs surgical intervention. When hip dislocation occurs during childhood surgical treatment consists of tenotomies, femoral varus derotation osteotomy (VDRO), and acetabuloplasty. Relapse is observed in one-fifth of cases during adolescence. In this prospective cohort study, we performed a descriptive evaluation of translation and rotation across VDROs in children with neuromuscular disorders and syndromes by radiostereometric analysis (RSA)...
April 2017: Acta Orthopaedica
Bruno Dohin, Elie Haddad, Hassan Al Khoury Salem, Mohamed Merhez Kilani
OBJECTIVE: Hip internal rotation (HIR) during gait is one of the main functional disorders related to cerebral palsy (CP) in children. Most of the procedures proposed rotational osteotomy of the femur (FRO), (and/or tibia). However, multilevel surgery (SEMLS) including bone procedure, implicates more difficult and longer rehabilitation. When bone deformity is moderate, the authors hypothesized that FRO could be avoided. They developed a soft tissues procedure to improve HIR. The aim of the study was assessment of the procedure...
September 2016: Annals of Physical and Rehabilitation Medicine
Flavia Coroian, Bertrand Coulet, Claire Jourdan, Olivier Choquet, Isabelle Laffont
OBJECTIVE: The musculotendinous retractions are common complications of central neurological damage with consequences for comfort and function. Treatment of uncomfortable retractions is often surgical, mainly based on tendon gestures. The objective of this study was to evaluate the efficiency of percutaneous needle tenotomy in these indications. MATERIAL/PATIENTS AND METHODS: The indication was accepted at a medical-surgical consultation. Tenotomy was performed using an 18 Gauge needle...
September 2016: Annals of Physical and Rehabilitation Medicine
Christian A Refakis, Keith D Baldwin, David A Spiegel, Wudbhav N Sankar
BACKGROUND: Although many studies have separately investigated the treatment of developmental dysplasia of the hip and spastic hip disease, little data exist regarding the treatment of infants with dislocated hips and underlying spasticity. The purpose of this study was to review our results after the surgical treatment of these infants. METHODS: We retrospectively reviewed all children below 3 years of age who underwent hip reconstruction for dislocated hips in the setting of cerebral palsy or other spastic/high-tone neuromuscular disease...
July 2, 2016: Journal of Pediatric Orthopedics
Kerstin Reidy, Christoph Heidt, Stefan Dierauer, Hanspeter Huber
BACKGROUND: Hip reconstructive surgery in cerebral palsy (CP) patients necessitates either femoral varus derotational osteotomy (VDRO) or pelvic osteotomy, or both. The purpose of this study is to review the results of a moderate varisation [planned neck shaft angle (NSA) of 130°] in combination with pelvic osteotomy for a consecutive series of patients. METHODS: Patients with CP who had been treated at our institution for hip dysplasia, subluxation or dislocation with VDRO in combination with pelvic osteotomy between 2005 and 2010 were reviewed...
August 2016: Journal of Children's Orthopaedics
Maximilian Martinez, Seung-Ju Kim, Sanjeev Sabharwal
BACKGROUND: Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients...
March 2017: Journal of Pediatric Orthopedics
İlker Abdullah Sarıkaya, Muharrem İnan, Ali Şeker
OBJECTIVE: The aim of this study was to determine the efficacy of semitendinosus and gastrocnemius tenotomies on popliteal angle presenting knee flexion spasticity in children with cerebral palsy (CP). METHODS: The study included 44 patients (25 males, 19 females; mean age: 8.1 years, range: 4 to 14 years) with spastic CP who underwent surgery for knee flexion spasticity. A total of 78 semitendinosus tenotomies and 28 associated gastrocnemius tenotomies were performed...
2015: Acta Orthopaedica et Traumatologica Turcica
Zoran Bozinovski, Neron Popovski
INTRODUCTION: Knee flexion is one of the main problems of the lower extremities in cerebral palsy patients. Many operative procedures are recommended for contractures of the knee in cerebral palsy patients. We performed simple operation and analyzed the results after operative treatment with nine years follow up. METHOD: 85 patients with spastic cerebral palsy were treated in period 2001 - 2010. 40 were ambulatory and 45 non ambulatory with ability to stand with support...
June 2014: Medical Archives
Pedro Gutierrez Carbonell
PURPOSE: Our objective was to study the pressure of the posterior superficial compartment of legs of children with spastic cerebral palsy and equinus deformity before and after a percutaneous tenotomy of the Achilles tendon. METHODS: We studied compartmental pressure in 28 percutaneous tenotomies of the Achilles tendon (18 patients). All patients suffered cerebral palsy: 19 were tetraplegics (67.9%) (Ashworth Grade 4, Gross Motor Function Classification System (GMFCS) Level IV), and 9 were hemiplegics (32...
February 2015: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Mathias Haefeli, Maurizio Calcagni
Spastic hemiplegia and cerebral palsy often lead to typical deformities of the upper extremity. Muscle- and joint-contractures may be painful and aesthetically unappealing and may interfere with function and hygiene. Within the first weeks after the cerebral incidence the vital threat is dominating and the exact amount of neurologic impairment is not assessable. During this period, conservative treatment should counteract the development of contractures. After spontaneous neurologic recovery, surgical options should be taken into account...
September 17, 2014: Praxis
Zoran Bozinovski, Neron Popovski
INTRODUCTION: Knee flexion is one of the main problems of the lower extremities in cerebral palsy patients. Many operative procedures are recommended for contractures of the knee in cerebral palsy patients. We performed simple operation and analyzed the results after operative treatment with nine years follow up. METHOD: 85 patients with spastic cerebral palsy were treated in period 2001-2010. 40 were ambulatory and 45 non ambulatory with ability to stand with support...
2014: Medicinski Arhiv
Troy J Boffeli, Rachel C Collier
Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers...
September 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
A Tinney, A Khot, N Eizenberg, R Wolfe, H K Graham
Lengthening of the conjoined tendon of the gastrocnemius aponeurosis and soleus fascia is frequently used in the treatment of equinus deformities in children and adults. The Vulpius procedure as described in most orthopaedic texts is a division of the conjoined tendon in the shape of an inverted V. However, transverse division was also described by Vulpius and Stoffel, and has been reported in some clinical studies. We studied the anatomy and biomechanics of transverse division of the conjoined tendon in 12 human cadavers (24 legs)...
June 2014: Bone & Joint Journal
Lisa C Drefus, Melanie A Buckland, Sherry I Backus, Leon Root
The purpose of this study was to determine the effect of a distal rectus femoris tenotomy on function and gait in adults with cerebral palsy who had diminished knee flexion during swing. A stiff knee gait pattern is commonly seen in individuals with cerebral palsy and frequently leads to tripping and falling. Five subjects, 25-51 years, (34.6±10.3 years) participated in the study; each individual had the surgery after the age of 18. Four of the five subjects underwent bilateral distal rectus femoris tenotomies for a total of nine limbs being studied...
2014: Gait & Posture
E De Pavía-Mota, S Neri-Gámez, G Reyes-Contreras, M Valencia-Posadas
UNLABELLED: Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy. MATERIAL AND METHODS: A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months...
March 2013: Acta Ortopédica Mexicana
Erik J Carlson, Michelle Gerwin Carlson
Swan neck deformity in patients with cerebral palsy can result from hand intrinsic muscle spasticity or overpull of the digital extensors. After accurate identification of the etiology of the deformity, surgical treatment is directed at correcting the underlying muscle imbalance. Intrinsic lengthening can be used to treat intrinsic muscle spasticity, whereas central slip tenotomy is employed when digital extensor overpull is the deforming force. Accurate diagnosis and application of the proper surgical technique are essential when treating swan neck deformity in patients with cerebral palsy...
April 2014: Journal of Hand Surgery
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