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Complications of osteotomies in severe cerebral palsy
P J Stasikelis1, D D Lee, C M Sullivan
1University of Chicago Hospitals, Illinois, USA.
Insights
Children with cerebral palsy undergoing hip osteotomies face complications. Nonambulatory status and gastrostomy/tracheostomy increase risks, but fractures and ulcers typically heal well.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Hip subluxation and dislocation are common in children with cerebral palsy.
- Osteotomy surgery aims to correct hip deformities but carries risks.
Purpose of the Study:
- To identify risk factors for postoperative complications following hip osteotomies in children with cerebral palsy.
- To analyze the incidence of death, fracture, and decubitus ulcers after surgery.
Main Methods:
- Retrospective study of 79 consecutive children with cerebral palsy.
- Analysis of postoperative complications including death, fractures, and decubitus ulcers.
- Correlation of complications with patient factors like ambulatory status and presence of gastrostomy or tracheostomy.
Main Results:
- 25% of patients experienced at least one complication.
- Complications were significantly higher in nonambulatory patients (29%) compared to ambulatory patients (8%).
- Children with gastrostomies or tracheostomies had a higher complication rate (68%) than those without (12%).
Conclusions:
- Ambulatory function is a significant predictor of complications after hip osteotomies in cerebral palsy.
- Nonambulatory status combined with a gastrostomy or tracheostomy indicates a substantially elevated risk.
- Fractures and decubitus ulcers, while common, were managed conservatively and healed without surgical intervention.
Abstract:
Seventy-nine consecutive children with cerebral palsy who underwent osteotomies about the hip for subluxation or dislocation were studied retrospectively to determine risk factors that would correlate with postoperative complications of death, fracture, or decubitus ulcer. Except for the three patients who died, all of the children had > or = 1 year of follow-up. Twenty (25%) patients had at least one complication. Three children died; one at 1 week, one at 2 weeks, and one at 5 months after surgery. Sixteen patients sustained 25 fractures. All were managed with cast or splint immobilization in the clinic. Five patients developed decubitus ulcers requiring > or = 2 weeks of local care, but none required skin grafts or flaps. Complications occurred in 13 (68%) of 19 children with gastrostomies or tracheostomies but in only seven (12%) of the remaining 60 children. Only one (8%) of 13 ambulatory patients had a complication compared with 19 (29%) of 66 nonambulatory patients. In conclusion, ambulatory function correlates well with the risk of complications after osteotomies. A nonambulatory patient with a gastrostomy or tracheostomy is at even greater risk. Fortunately the fractures and ulcers observed in this series healed uneventfully with no operative intervention.