Clinical and radiological characteristics of hip joints in children with cerebral palsy

Authors

  • Mykola Lyutkevych
  • Oleksandr Korolkov

DOI:

https://doi.org/10.15674/0030-59872014172-80

Keywords:

cerebral spastic infantile paralysis, hip joint, pathology, diagnostics

Abstract

Abnormalities of development of hip joints (HJ) in children with cerebral palsy (CP) lead to hip decentration, subluxation and dislocation. Spastic hip subluxation and dislocation is a significant problem in patients with CP and leads to significant disturbances of self-service and movement functions.

Purpose: to identify patterns of development of HJ in children with CP basing upon retrospective clinical and radiographic analysis.

Methods: this work is based on an analysis of 148 medical records of children with CP with hip subluxation and dislocation treated at the hospital. There were 86 boys and 62 girls among them. All patients were divided into 3 age groups (from 1 to 6 years, from 6 12 years, and from 12 to 18 years) as well as according to mode of CP: hemiparetic mode was in 24.3% of cases (36 patients), double hemiparesis (tetraparesis) - in 13.5% (20 patients), spastic diplegia - in 37.2% (55 patients), hyperkinetic mode - in 10.8% (16 patients), atonic-astatic mode - in 6.1% (9 patients), and mixed one - in 8.1% (12 patients). Concerning the level of motor activity according to the GMFCS classification all patients were divided as follows: in 61 patients (41.2%) there were marked movement disorders of the 2nd level, in 50 (33,8%) patients – the 3rd level, and in 37 (25,0%) – the 4th level.

Results: dynamics of main indexes of HJ development were analyzed and direct dependence of the degree of pathological changes in HJ in children with CP on the severity of neurological and orthopedic deficit was revealed. Clinically, the most informative sign is magnitude and dynamics of limitations of hip abduction and extension (severity of hip flexion-adduction contracture) which correlates with value of migration index (MI). We strongly insist on exacerbation of orthopedic cautions in the "non walking" children (GMFCS III, IV, V) concerning development and progression of HJ pathology. The beginning of spastic hip subluxation and dislocation has usually no clinical manifestations. Examining the children with CP one must follow the principle: to define HJ abnormal until otherwise will not be proven. We recommend to make panoramic X-ray films of the pelvis in all children with CP at the age of 1 year for screening assessment of pathological changes in HJ and for further dynamic surveillance. The main attention should be paid to the analysis of the values of the MI, Wìberg's angle (WA) and acetabular index (AI).

Conclusions: clinical examination and analysis of the pelvis panoramic radiographs in children with CP allow to distinguish clinical groups and to define individual approaches to the choice of medical (including surgical) tactics and to keeping children of this category. MI clearly correlates with the femoral neck-shaft angle, AI and WA, and the dynamics of these indexes allows to use them as prognostic indicators of HJ development. Discovered anatomical and functional differences between the signs of congenital and spastic hip dislocation in children with CP have to be used in daily practice of children's orthopedics-traumatologists and must be taken into account while planning medical therapies (conservative and/or surgical) for eliminating HJ pathology.

References

  1. Order Ministry of Health Ukraine of 09.04.2013, № 286 "Cerebral palsy and other organic brain damage in children who are accompanied by movement disorders." Adapted clinical guidelines based on evidence.
  2. Dyukendzhiev E. P. Bionics in habilitation. Cerebral palsy and spinal disease. Robotic reciprocal complexes / E. P. Dyukendzhiev. — T. II. — Riga: RTU Publishing House, 2013. — 100 р.
  3. Regulation of posture and walk with cerebral palsy and some ways of correcting / I. S. Perhunova, V. M. Luzinovich, E. G. Sologubov [et al.] — Moscow, 1996. — 244 р.
  4. Mezhenina E. P. Cerebral spastic paralysis and their treatment / E. P. Mezhenina. — Kiev: Health, 1966. — 224 р.
  5. Korolkov O. I. Current issues orthopedic treatment of children with cerebral palsy / O. I. Korolkov, S. D. Shevchenko, M. I. Lyutkevych // Annals of Traumatology and Orthopedics. — 2009. — № 1-2. — P. 54-58.
  6. Vidal J. The anatomy of the dysplastic hip in cerebral palsy related to prognosis and treatment / J. Vidal, P. Deguillaume, M. Vidal // International Orthopaedics. — 1985. — Vol. 9. — P. 105–110.
  7. Bozinovski Z. Soft tissue surgical procedures in the prevention of hip dislocation in patients with cerebral palsy / Z. Bozinovski, G. Zafiroski // Georgian Med News. — 2008. — Vol. (157). — P. 7–10.
  8. Cooke P. H. Dislocation of the hip in cerebral palsy. Natural history and predictability / P. H. Cooke, W. G. Cole, R. P. L. Carey // J. Bone Joint Surg. — 1989. — Vol. 71-B (3). — Р. 441–446.
  9. Hip surveillance in children with cerebral palsy / F. Dobson,R. N. Boyd, J. Parrott [et al.] // J. Bone Joint Surg. — 2002. — Vol. 84-B. — P. 720–726.
  10. Bleck E. E. Orthopedic management cerebral palsy / E. E. Bleck. — Oxford, Philadelrhia. Mac Keith Press, 1987. — 499 p.
  11. Novacheck T. F. Orthopedic management of spasticity in cerebral palsy / T. F. Novacheck, J. R. Gage // Childs Nerv. Syst. — 2007. — Vol. 23. — P. 1015–1031.
  12. Umnov V. V. Complex orthopedic and neurological treatment of patients with spastic paralysis: abstract dis. ... doctor medical sciences: 14.00.22 with "Traumatology and Orthopaedics", 14.00.28 "neurosurgery" / V. V. Umnov. — St. Petersburg, 2009 — 20 p.
  13. Gamble J. G. Established hip dislocations in children with cerebral palsy / J. G. Gamble, L. A. Rinsky, E. E. Bleck // Clin. Orthop. — 1990. — Vol. 253. — Р. 90–99.
  14. Pountney T. Hip dislocation in cerebral palsy / T. Pountney, E. Green // BMJ. — 2006. — Vol. 332. — P. 772–775.
  15. Korolkov A. I. Сonceptual approaches to diagnosis and preventive treatment of subluxation and dislocation of the hip in children with cerebral palsy / A. I. Korolkov, N. I. Lyutkevуch, A. V. Haschuk // Orthopaedics, Traumatology and Prosthetics. — 2013. — № 2 (591). — P. 114-122.
  16. Marks V. O. Orthopedic Diagnosis / V. O. Marks. — Minsk: Science and Technology, 1978. — 511.

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How to Cite

Lyutkevych, M., & Korolkov, O. (2014). Clinical and radiological characteristics of hip joints in children with cerebral palsy. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 72–80. https://doi.org/10.15674/0030-59872014172-80

Issue

No. 1 (2014)

Section

ORIGINAL ARTICLES

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Copyright (c) 2014 Mykola Lyutkevych, Oleksandr Korolkov

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