Orthopedic traumatologists of the Okhmatdyt Clinical Center for Children’s Medicine successfully performed a complex intervention on the hip joint of a child with cerebral palsy
The boy has a severe form of cerebral palsy (CP) with significant developmental delay.
In addition to the neurological deficit, the child was diagnosed with a left hip dislocation and a right subluxation.
“Children with cerebral palsy are usually born with healthy hip joints, but in the process of their growth and development, muscle imbalance (most often spastic syndrome), in the absence of certain preventive measures, often leads to the development of instability of the hip joints, deformations of the feet and spine, and other abnormalities in the locomotor system,” said Oleksandr Korolkov, head of the Center’s neuroorthopedics, traumatology and rehabilitation clinic.
As the doctor explained, due to severe spasticity, the child’s legs were in the “crossed” position for a long time, which led to the gradual development of hip dislocation. This is a deviation in the structure of the joint, when the head of the femur completely protrudes from the acetabulum, thereby leading to the dislocation of this bone with impaired blood supply and destruction of the cartilage and bone structure of the joint, limitation of movements, secondary curvature of the spine and the development of pain syndrome.
The doctors of the Center emphasize that, provided the correct position of the legs, constant stretching of certain muscles, timely orthoses and rehabilitation from 4 hours a day, these complications can be completely prevented. After a comprehensive examination of the child, the Center’s doctors decided to perform surgery on the left leg first. In the future, another operation awaits the boy – on the opposite hip joint.
“We performed on Bohdan a detorsion and varisation osteotomy of the femur with fixation with a special titanium plate and an osteotomy of the pelvic bone to form a “roof” of the joint so that there is no repeat dislocation in the future. Due to such interventions, the centering of the femoral head in the acetabulum was achieved. To fix the operated limb in the correct position, we apply a plaster bandage for 6 weeks, and this plate remains inside for a certain time until the fusion of the hip fragments,” said Oleg Tokai, trauma surgeon of the Center.
The doctors also injected botulinum toxin under ultrasound control into the spasmodic muscles of the back, which provoked the development of spastic scoliosis in the child. During the postoperative treatment of the hip joints, the boy developed pneumonia. So the baby was transferred to the allergy-pulmonology department of the Center.
“We normalized his condition and blood test results, everything is fine on the ultrasound. The treatment was successful,” said Victoria Bergtravm, head of the pulmonology department.
Little Bohdan will undergo a rehabilitation course at the Children’s Rehabilitation Clinic, which was opened in the Children’s Medicine Center this summer.
Photo – Children’s Medicine Center. “Okhmatdyt” Hospital.