Medial transphyseal screw placement for spastic hip treatment in children with cerebral palsy. Effectiveness and safety

  • Francisco Praglia Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina) https://orcid.org/0000-0002-4576-8350
  • Juan Pablo Cucchiara Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina) https://orcid.org/0000-0002-3105-7478
  • Florencia Lucioni Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina) https://orcid.org/0000-0002-9097-5113
DOI: https://doi.org/10.15417/issn.1852-7434.2020.85.3.1016
Keywords: Spastic hip, screw, proximal femur, children.

Abstract

Introduction: Animal and clinical studies have shown promising results for the varus-producing placement of a medial eccentric transphyseal screw. The purpose of this study was to establish if the placement of a screw in the proximal femur is an effective and safe approach for spastic hips in children with cerebral palsy (CP). Materials and Methods: We compared two groups of pediatric CP patients (Gross Motor Function Classification System [GMFCS] III, IV and V) with “hips at risk.” Group A patients were treated with soft-tissue release plus a medial eccentric transphyseal screw in the proximal femur. Group B patients were only treated with soft-tissue release. Patients were evaluated pre- and postoperatively to determine their Rang test score, Reimer’s migration percentage (MP), neck-shaft angle (NSA), and complications. Results: From a total of 18 patients operated, 36 hips 55% (10) belonged to Group A and 45% (8) to the Group B. The median age was 51 months (IQR, 41-108). The median follow-up was 3 years (IQR, 2.4-5.8). The comparative analysis of all preoperative and postoperative variables yield only one statistically significant difference: the median left hip NSA (-5 vs. 0, P 0.02). Conclusions: The release of soft tissues was effective to prevent the spastic hip dislocation. The placement of medial eccentric transphyseal screw in spastic hips produced some complications and no beneficial changes. Medial hemiphysiodesis of the hip remains nothing but an attractive theoretical solution for the treatment of problems caused by excessive valgus. However, further studies are warranted. Level of Evidence: III

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Author Biographies

Francisco Praglia, Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina)
Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina)Pediatric Trauma Unit, Hospital Nacional “Prof. Alejandro Posadas” (Buenos Aires, Argentina)
Juan Pablo Cucchiara, Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina)
Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina)
Florencia Lucioni, Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina)
Pediatric Orthopedic Surgery Department, Maternal and Child Section, Hospital Militar Central “Cir. Mayor Dr. Cosme Argerich” (Buenos Aires, Argentina)

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Published
2020-08-03
How to Cite
Praglia, F., Cucchiara, J. P., & Lucioni, F. (2020). Medial transphyseal screw placement for spastic hip treatment in children with cerebral palsy. Effectiveness and safety. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(3), 222-233. https://doi.org/10.15417/issn.1852-7434.2020.85.3.1016
Issue
Vol 85 No 3 (2020)
Section
Clinical Research
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