Outcome of Single Event Multilevel Soft Tissue Release for Spastic Diplegic Cerebral Palsy.

Objective: We evaluated the results of single event multilevel surgery for treatment of contractures of lower extremities in spastic diplegic cerebral palsy patients in Phramongkutklao Hospital. Material and Method: The present study included 40 patients (23 boys, 17 girls, mean age 8.9 years) with spastic diplegic cerebral palsy, who underwent single event multilevel surgery for the treatment of soft tissue contractures in lower extremities secondary to spasticity between 2006 and 2009. Evaluations were based on pre- and post-operative (follow-up for three years), physical examination, and video observational gait pattern on the Gross Motor Function Classification System (GMFCS) scores and Functional Mobility scales (FMS). Results: Range of motion of all operated joints were increased post-operatively, resulting in significant improvement in posture, gait, and balance of patients. The mean GMFCS scores were 4.2 pre-operatively, 4.1 at post-operatively 1-year, 3.8 at post-operative 2-year, and 3.0 at post-operative 3-year, which were significantly improved two and three years post-operative period (p<0.05). The mean FMS scores were improved at 5 meters post-operative at 1-, 2-, and 3-year (p<0.05). The mean FMS scores at 50 meters were improved at 3-year post-operative period. Conclusion: Single event multilevel surgery can help spastic diplegic cerebral palsy patients improve range of motions, gait patterns, and mobility functions.

Surgical correction of coxa vara: Evaluation of neck shaft angle, Hilgenreiner-epiphyseal angle for indication of recurrence.

BACKGROUND: Coxa vara is a hip deformity in which the femoral neck-shaft angle decreases below its normal value. Standard surgical treatment for this condition is corrective valgus osteotomy. Appropriate correction of the Hilgenreiner-epiphyseal angle is important to prevent recurrence. The purpose of this study is to: 1) evaluate the recurrence of the deformity at the latest follow up; and 2) find the appropriate angle of correction associated with the lowest recurrence. METHODS: 34 hips in 31 patients who underwent surgery for treatment of coxa vara from 2005 to 2014 were included. Patient-reported outcomes, Hilgenreiner-epiphyseal angle, and neck-shaft angle were assessed preoperatively, postoperatively, and at latest follow-up. RESULTS: The mean age at surgery was 10.99, with a range of 5-30, years. Preoperative neck-shaft angle ranged from 60 to 100 degrees, and Hilgenreiner-epiphyseal angle ranged from 60 to 90 degrees. At the latest follow up, the neck-shaft angle ranged from 120 to 135 degrees and the Hilgenreiner-epiphyseal angle ranged from 22 to 35 degrees (p < 0.001). The Harris hip score improved from 47.20 (34-66) to 79.68 (60-100) (p < 0.001). There was no recurrence of deformities at the mean follow up of 37.87 months. CONCLUSION: Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to > 120 degrees in order to prevent recurrence of the deformity. Majority of the patients were reported improvement of hip function. However, a longer-term follow up is required to determine further outcomes regarding to recurrence of the deformity.