Abstract

PRAGLIA, Francisco; LUCIONI, Florencia  and  CUCCHIARA, Juan Pablo. Colocación de un tornillo transfisario medial en la cadera espástica de niños con parálisis cerebral. Eficacia y seguridad. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2020, vol.85, n.3, pp.222-233. ISSN 1852-7434.  http://dx.doi.org/https://doi.org/10.15417/issn.1852-7434.2020.85.3.1016.

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 series of pediatric CP patients (Gross Motor Function Classification System [GMFCS] III, IV and V) with “hips at risk.” Series A patients were treated with soft-tissue release plus a medial eccentric transphyseal screw in the proximal femur. Series B patients were only treated with soft-tissue release. Patients were evaluated pre and postoperatively to determine their Rang test score, Reimer’s migration index (MI), diaphyseal cervical angle, and complications. Results: From a total of 18 patients operated, 36 hips, 55% (10) belonged to the A Series and 45% (8) to the B Series. 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 diaphyseal cervical angle (-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.

Keywords : Spastic hip; screw; proximal femur; children.

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