Multi-level lower limb deformities : how can a pediatric orthopedic team manage a successful transition to adulthood?
Nejib KHOURI | Éric DESAILLY
Seance of wednesday 06 december 2023 (l'ANC reçoit la SOFCOT : Table ronde Transition Enfant/Adulte du sujet Paralysé Cérébral marchant)
DOI number : 10.26299/3qsz-vj77/emem.2023.35.03
Abstract
Orthopedic deformities that are likely to progress and lead to greater functional impairment in late growth and adulthood will be treated in anticipation of this deterioration. The mechanical concepts guiding the proposed interventions share a common principle: correcting adverse joint levers and restoring optimal muscular balance.
Quantified gait analysis (QGA) is of recognized value in understanding gait disorders in patients with cerebral palsy, with the aim of selecting the best procedures on a personalized basis. It is also of major interest in the clinical and scientific evaluation of the effects of orthopedic surgery on gait. Instrumental gait analysis data complements the clinical examination and cannot be dissociated from it. Although there is variability in the surgical details of therapeutic strategies, QGA has a definite effect on surgical program design and outcome improvement.
Compared with GMFCS I and II walkers, the functional status of GMFCS III patients is variable with age. Their condition may be deteriorated by a vicious attitude, hip dislocation, multi-stage deformities of the lower limbs, leading to motor dysfunction and eventual loss of the ability to walk.
Conservative hip reconstruction surgery in GMFCS III patients gives good clinical and radiological results. It must avoid joint destruction that could lead to joint replacement surgery.
Recent advances in 3D modeling of bone architecture, and the proposal of specific patient guides, raise hopes that the surgical procedure will be better tailored to preoperative planning.
Quantified gait analysis (QGA) is of recognized value in understanding gait disorders in patients with cerebral palsy, with the aim of selecting the best procedures on a personalized basis. It is also of major interest in the clinical and scientific evaluation of the effects of orthopedic surgery on gait. Instrumental gait analysis data complements the clinical examination and cannot be dissociated from it. Although there is variability in the surgical details of therapeutic strategies, QGA has a definite effect on surgical program design and outcome improvement.
Compared with GMFCS I and II walkers, the functional status of GMFCS III patients is variable with age. Their condition may be deteriorated by a vicious attitude, hip dislocation, multi-stage deformities of the lower limbs, leading to motor dysfunction and eventual loss of the ability to walk.
Conservative hip reconstruction surgery in GMFCS III patients gives good clinical and radiological results. It must avoid joint destruction that could lead to joint replacement surgery.
Recent advances in 3D modeling of bone architecture, and the proposal of specific patient guides, raise hopes that the surgical procedure will be better tailored to preoperative planning.