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    Heterotopic ossification following hip osteotomies in cerebral palsy: Incidence and risk factors
    (Lippincott Williams & Wilkins, 2006) Inan, Muharrem; Chan, Gilbert; Dabney, Kirk; Miller, Freeman
    The aims Of this Study are, first, to determine the incidence of heterotopic ossification (HO) in patients with cerebral palsy (CP) who have undergone pelvic and/or proximal femoral osteotomies and, second, to identify any risk factors that may, contribute to its development in this patient population. The radiographs of 219 consecutive patients with CP who underwent proximal femoral osteotomies with or without pelvic osteotomies were reviewed. Risk factors including gender, age, and degree of involvement, ambulatory status, previous hip operations, bilateral hip surgery, capsular release, concomitant pelvic osteotomy. infection, and history of exuberant callus were evaluated. Thirty-five (16%) patients were diagnosed with HO and the 5 factors that cause HO were identified, which are degree of involvement (quadriplegic), ambulatory status, capsular release, infection, and previous hip operations. Based on logistic regression analysis. if a patient had quadriplegic type of CP, then they have 17.5 times more risk for HO than a patient with hemiplegic type, and capsular release increases the risk 237 times. Although HO Occurred in 16% of patients treated with bony procedures in the hip, in a small group (2%) of children it had a clinically significant limitation requiring surgical resection. In this Study, clear risk factors were presented for the development of HO; however, none of these risk factors can be altered in ways that will reduce the risk for HO. These risk factors might be used to define a high-risk group in whom attempts at prophylactic treatment lot, prevention of HO Could be initiated.
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    Pectoralis major release to improve shoulder abduction in children with cerebral palsy
    (Lippincott Williams & Wilkins, 2007) Domzalski, Marcin; Inan, Muharrem; Littleton, Aaron G.; Miller, Freeman
    The aim of our study was to evaluate the surgical results after pectoralis major muscle release in children with cerebral palsy and to assess a caregiver's satisfaction in patient's care after this procedure. Twenty-one shoulders in 13 patients were analyzed at least 12 months after surgery. All but 1 patient involved in our study had quadriplegic type of cerebral palsy involvement. In 17 limbs, only pectoralis release was performed; in 4 limbs, latissimus dorsi release was added. After clinical examination, a questionnaire was used to determine the caregiver's assessment. The passive range of abduction and flexion was maintained at an angle greater than 90 degrees in 10 patients. External rotation was restricted in 6 patients. All caregivers would recommend this surgery to another patient. All but one reported improvement in care of the patients after surgery. The indication for this surgical procedure is limited only to the selected cerebral palsy cases in which custodial care is impaired by shoulder adduction contracture. The 2 main indications for the procedure are the limitations in the ability to bathe the axilla and the difficulty in dressing.
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    Unilateral versus bilateral peri-ilial pelvic osteotomies combined with proximal femoral osteotomies in children with cerebral palsy: Perioperative complications
    (Lippincott Williams & Wilkins, 2006) Inan, Muharrem; Senaran, Hakan; Domzalski, Marcin; Littleton, Arron; Dabney, Kirk; Miller, Freeman
    The purpose of this study is to evaluate if bilateral peri-ilial pelvic osteotomies (PIPO) combined with proximal femoral varus derotation osteotomies (VDRO) influenced postoperative complications in children with spastic quadriplegia. Bilateral and unilateral hip subluxation or dislocation secondary to spasticity was present in 29 and 61 patients, respectively. The children were divided into 2 groups: group I were to be performed a surgery for unilateral PIPO associated with bilateral VDRO, and group 2 were to be performed a surgery for bilateral PIPO and VDRO. The average age of patients at initiation Of Surgery was 11.7 years (range 5-20 years) for group 1 and 10.7 years (range, 5-19 years) for group 2. The hospital stay was similar for group 1 and 2 (P = 0.797), which was 9 days. In group 1, 11 (18%) of 61 children needed an average of 2 days (range, 1-7 days) in the intensive care unit postoperatively, and 4 of these 11 patients were reintubated because of respiratory problems. In group 2, 6 (20%) of 29 children were transferred to the intensive care unit postoperatively for all average of 2 days (range, 1-4 days) and 3 of these 6 children were reintubated because Of respiratory problems. In conclusion, respiratory problems and anemia were the most common early postoperative complications. which occur with a similar rate in children with spastic quadriplegia who underwent bilateral or unilateral peri-ilial pelvic osteotomy(ies) combined with proximal femoral osteotomies. We believe that bilateral hip procedures including PIPO, proximal femoral osteotomies, and soft-tissue release call be performed safely in I stage and, based on this data, the staged procedure would probably have the same risk as the first procedure.