Browsing by Author "Bajin, Zoran (6603547192)"

This article summarises a comparative retrospective study (1983-2001) of 42 consecutive spastic-diplegic ambulatory patients (aged 2-10 years) by examining the radiographic and clinical results of two soft-tissue procedures for paralytic hip subluxation (PSH). Group A comprised 20 patients (26 PSHs) who were treated by iliopsoas tenotomy, and group B comprised 22 patients (31 PSHs) who were treated by rectus femoris and iliopsoas tenotomy with iliac crest resection (sartorius release). All patients had bilateral adductor tenotomies. At 8.8 years mean follow-up, group A migration percentages (MP) improved from 39.8% to 24.7% with 92.3% good/average results. At a mean follow-up period of 8.3 years, group B improved from 58.0% to 25.9% with 96.8% good/average results. Long-term hip reduction was achieved in 84.6% of group A and 80.6% of group B hips. Relative MP correction was superior in group B. No patient had MP progression in either the PSH or non-PSH hip. Walking ability improved in 55% of group A and 86% of group B patients (Functional Mobility Scale). In conclusion, we recommend release of all the principle hip flexors: rectus femoris, sartorius, and iliopsoas, coupled with adductor tenotomies, in this patient group. © 2007 Springer-Verlag.

Femoral derotation osteotomy is used to treat increased femoral neck anteversion and to correct medial hip rotation deformity in patients with cerebral palsy. We investigated if there were significant differences between planned and achieved corrections of increased femoral neck anteversion and whether our method influenced walking ability and number of complaints. We retrospectively evaluated 17 ambulatory patients (21 femurs) with cerebral palsy and medial rotation deformity of the hip. The new method of determining femoral derotation osteotomy precisely and simply using tables was applied. The average followup was 11 years (range, 3-20 years), and the average age of the patients was 20 years (range, 9-42 years). The average planned correction of femoral neck anteversion was 31.9° (range, 20°-45°), and the average achieved correction was 32.19° (range, 15°-40°). Of the 17 patients evaluated, 13 no longer had complaints. Deterioration of walking ability was not observed in any patients. The new method of determining femoral derotation osteotomy precisely and simply corrects femoral neck ante- version in patients with cerebral palsy and medial rotation deformity of the hip, leading to reduction in complaints and improved walking ability. © 2006 Lippincott Williams & Wilkins, Inc.

Aim: This study evaluates the effects of three surgical procedures in the treatment of pronation deformities of the forearm in cerebral palsy patients; namely the transposition of pronator teres to extensor carpi radialis brevis muscle; and rerouting of the pronator teres muscle with or without pronator quadratus muscle myotomy. Methods: Sixty-one patients, 48 male/13 female, with a mean age of 17 years (5-41 years) were treated between 1971 and 2011. Pronator teres transposition was performed in 10, pronator rerouting in 35, and pronator rereouting with pronator quadratus myotomy in 16 patients. Ranges of motion, and assessments using the Quick Dash, Mayo Scoring, and Functional Classification system of upper extremity, were made before and after surgery. Mean follow-up was 17.5 years (3-41 years). Results: All three procedures led to significantly improved ranges of motion and upper limb function, with good/excellent results in 80 % of patients. Mean active supination improved from 10 ° (0-60 °) to 85 ° (30-90 °) (p < 0.001). There were significant improvements in Functional Classification system for the upper extremity scores (p < 0.003), Mean Quick Dash Scores improved from 58.41 (38.63-79.54) to 44.59 (27.27-68.18), and mean MEPS improved from 68 (30-85) to 84 (60-100) following surgery. All three techniques had statistically improved MEPS following surgery (p < 0.001); only the pronator teres muscle rerouting with pronator quadratus myotomy showed an improved Functional Classification system for the upper extremity score (p < 0.05); and only the pronator teres rerouting procedure showed an improved Quick Dash score (p < 0.05). There were no statistically significant differences in outcomes between different ages groups, and no significant differences between isolated pronator teres muscle rerouting were compared with those undergoing simultaneous treatment of carpal flexion and thumb adduction deformities (p > 0.05). Conclusion: Surgery is very effective in the management of pronation deformities of the forearm in patients with cerebral palsy. Isolated pronator teres rerouting is probably the most effective and simple technique. Adjunctive pronator quadratus myotomy does not lead to an improvement in the results and requires an additional surgical approach. There should be no age restriction to surgery, as all age groups appear to benefit from similar improvements in range of motion and upper limb function. © 2015 Čobeljić et al.