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Sarikaya IA, Birsel SE, Erdal OA, Görgün B, Şeker A, İnan M. Treatment of Hip Dislocation in Cerebral Palsy with Extraarticular Intervention. Acta Chir Orthop Traumatol Cech 2023; 90:92-99. [PMID: 37155997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
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Affiliation(s)
- I A Sarikaya
- Ortopediatri Academy of Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - S E Birsel
- Ministry of Health Basaksehir Pine and Sakura City hospital, Department of Orthopaedics and Traumatology, Basaksehir, Istanbul, Turkey
| | - O A Erdal
- Ortopediatri Academy of Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - B Görgün
- Ortopediatri Academy of Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - A Şeker
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopaedics and Traumatology, Kocamustafapasa, Istanbul, Turkey
| | - M İnan
- Ortopediatri Academy of Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
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Ertan Birsel S, Sarıkaya İA, Erdal OA, Görgün B, İnan M. The Coexistence of Spontaneous Femoral Nerve Palsy and Developmental Dysplasia of the Hip in a Breech-Presenting Newborn: A Rare Case Presentation. JBJS Case Connect 2021; 11:01709767-202112000-00046. [PMID: 34762612 DOI: 10.2106/jbjs.cc.21.00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE In this report, we present an infant who was diagnosed with femoral nerve palsy (FNP) and developmental dysplasia of the hip (DDH) on the same side after delivery. The patient was treated with hip alternative abduction orthosis, which did not force hip flexion with satisfactory results. CONCLUSION FNP in newborns with DDH is usually described as a possible complication of the Pavlik harness treatment. However, there is only one report that presents 2 cases. Our objective is to raise awareness of this very rare condition because performing an early intervention is vital to achieving an optimal therapeutic result.
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Affiliation(s)
- Sema Ertan Birsel
- Department of Orthopaedics and Traumatology, Turkish Ministry Of Health Başakşehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - İlker Abdullah Sarıkaya
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
| | - Ozan Ali Erdal
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
| | - Barış Görgün
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
| | - Muharrem İnan
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
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Abstract
PURPOSE Changes to routine clinical approaches during the corona virus disease 2019 (COVID-19) pandemic are necessary to decrease the risk of infection in patients and healthcare providers. Because the treatment of many conditions is time sensitive, it is crucial to modify the management of paediatric orthopaedic cases by minimizing any subsequent morbidity. Our purpose was to describe the different measures and management strategies that have been applied by paediatric orthopaedic surgeons and to show how paediatric orthopaedic practice is affected in Turkey. METHODS All active practicing members of the Turkish Society of Children's Orthopedic Surgery (TSCOS) were contacted via telephone and asked to fill out a survey (24 questions). For participants, either an email or web link was sent to their mobile phones. An online survey generator was used. RESULTS A total of 54 survey responses were collected, for a response rate of 55%. In all, 62% reported a 75% decrease in their outpatient frequency, whilst 75% reported a 75% decrease in their surgery frequency. A total of 86% of the performed surgeries were emergency cases. None of the participants performed elective surgeries, and 61% did not have the consent form specific to COVID. Choice of protective measures have changed considerably; 96% stated that they needed an algorithm to follow for situations such as pandemic. CONCLUSION This national survey revealed that the COVID-19 pandemic has had a detrimental effect on paediatric orthopaedic practice and practitioner response varies in terms of reactions and precautions. The necessity of creating a protocol based on what we have learned must be taken into consideration. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Sema Ertan Birsel
- Atlas University, Istanbul Medicine Hospital, Department of Orthopaedics and Traumatology, Bağcılar, Istanbul, Turkey
| | - İlker Abdullah Sarıkaya
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey,Correspondence should be sent to İlker Abdullah Sarıkaya, Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey. E-mail:
| | - Ali Şeker
- Istanbul University- Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopaedics and Traumatology, Kocamustafapasa, Istanbul, Turkey
| | - Ozan Ali Erdal
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - Barış Görgün
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - Muharrem İnan
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
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Sarıkaya İA, Birsel SE, Şeker A, Erdal OA, Görgün B, İnan M. The split transfer of tibialis anterior tendon to peroneus tertius tendon for equinovarus foot in children with cerebral palsy. Acta Orthop Traumatol Turc 2020; 54:262-268. [PMID: 32544062 DOI: 10.5152/j.aott.2020.03.571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the results of the split anterior tibialis tendon transfer (SPLATT) to peroneus tertius (PT) for equinovarus foot deformity in children with cerebral palsy (CP). METHODS The medical records of 25 ambulatory CP patients (mean age: 8.7±3.2 years, range: 4-16 years) with equinovarus foot (33 feet), who underwent SPLATT to PT surgery between 2014 and 2016, were retrospectively reviewed. A senior surgeon performed all the surgical procedures. SPLATT was performed as part of a single-event multilevel surgery for the lower limb, and the concomitant procedures on the same extremity were recorded. The patients who required any additional foot or ankle surgery that could affect the clinical outcome (except heel cord lengthening) were excluded from the study. The Kling's College Criteria were used to evaluate the procedural outcome of the foot position and gait, and the associated complications were recorded. RESULTS The mean follow-up time was 28.8±5 months (range: 24-42 months). The postoperative Kling scores were excellent for 27 feet of the patients who had a plantigrade foot, without fixed or postural deformity, in a regular shoe, having no calluses; good for 5 cases for those who walked with less than 5° varus, valgus, or equinus posture of the hind foot, wearing regular shoes, having no callosities; and fair for 1 case for those who had recurrence of the deformity. There was only one wound detachment, which was treated with wound care and dressing. None of the patients had overcorrection, infection, or bone fracture. CONCLUSION The dynamic SPLATT to PT surgery for the management of the equinovarus foot deformities in the CP patients is a safe and less complicated surgical alternative with a good functional outcome. It is a safe and effective treatment method for the management of equinovarus foot deformities in CP. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- İlker Abdullah Sarıkaya
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
| | - Sema Ertan Birsel
- Department of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey
| | - Ali Şeker
- Department of Orthopaedics and Traumatology, İstanbul University Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ozan Ali Erdal
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
| | - Barış Görgün
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
| | - Muharrem İnan
- Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey
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İnan M, Sarıkaya İA, Şeker A, Beng K. A combined procedure for irreducible dislocation of patella in children with ligamentous laxity: a preliminary report. Acta Orthop Traumatol Turc 2015; 49:530-8. [PMID: 26422349 DOI: 10.3944/aott.2015.15.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. The most common complaints due to this condition are inability to walk, delayed walking, and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity. METHODS Fourteen knees of 9 patients operated on by a single surgeon between 2009-2012 were included in the study. The tensor fascia was divided into 2 strips, and these strips were passed via the joint and sutured to themselves. The combined procedure additionally includes lateral capsular release, vastus lateralis (VL) resection, medial capsular plication, and Z-plasty of the rectus femoris (RF) tendon. RESULTS Mean age at the time of surgery was 6.9±3.3 years (range: 4-13 years). The mean follow-up was 37.6±0.9 months (range: 26-49 months). Patellofemoral instability was restored for all patients by using combined surgical technique. Patellar lateralization developed in 2 patients, in whom stability was obtained via secondary medial plication. CONCLUSION Our results show that this combined surgical procedure stabilizes the knee and treats patellar dislocation accompanying ligamentous laxity in pediatric patients.
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Affiliation(s)
- Muharrem İnan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | | | - Ali Şeker
- İstanbul Medipol University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Kubilay Beng
- Baltalimanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
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Sarıkaya İA, İnan M, Şeker A. Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy. Acta Orthop Traumatol Turc 2015; 49:51-6. [PMID: 25803254 DOI: 10.3944/aott.2015.14.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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. Popliteal angle was measured under general anesthesia before and after surgery. Patients were divided into groups according to age (younger and older than 7 years), severity of deformity and type of CP. RESULTS Mean popliteal angles decreased by 14.3º (30.1%) following semitendinosus tenotomy and by 6.1º (12%) following gastrocnemius tenotomy (p=0.0001). The change in popliteal angle was not statistically significant according to age, severity of flexion spasticity, and type of CP palsy. There was a significant difference following gastrocnemius tenotomy between groups with a popliteal angle of greater or lesser than 50º (p=0.0001). CONCLUSION Semitendinosus and gastrocnemius tenotomies improved popliteal angle by 30.1% and 12%, respectively. Age, preoperative popliteal angle or anatomical disease classification did not a significantly affect popliteal angle.
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Affiliation(s)
| | - Muharrem İnan
- Department of Orthopedics and Traumatology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ali Şeker
- Department of Orthopedics and Traumatology, Medipol Mega Hospital, İstanbul Medipol University, İstanbul, Turkey
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