Palliative Schanz osteotomy for irreducible hip dislocation in adolescent patients with cerebral palsy
Abstract
Purpose of the study. Palliative Schanz osteotomy is one of the options for treatment of irreducible hip dislocation in adolescent patients with cerebral palsy.
Material. In 1992 to 2002, Schanz osteotomy was indicated on 46 occasions in 27 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9 to 18 years.
Methods. In the postoperative evaluation, emphasis was placed on the clinical presentation, i. e., improved motion of the hip joints and pain alleviation.
X-ray examination was carried out at 2 to 6 months after surgery. Results.
In all patients, the range of motion in the hip increased in abduction or flexion according to the osteotomy technique used. Because of severe pain, one patient (2.17 %) had to undergo subsequent resection of the femoral head.
Transient pain in the hip persisted in four patients (8.7 %). Discussion.
In patients older that 10 years, reconstructive surgery for neurogenic dislocations has an uncertain outcome and a palliative procedure is often the only method of choice for treatment of irreducible dislocations. Schanz angulation osteotomy can provide a better range of motion, alleviate pain and facilitate the care of patients, particularly if they are nonambulatory.
Conclusions. Schanz osteotomy is a less invasive method than resection of the proximal femur and should be used preferably in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.