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Management of hip dislocation with postural management
Teresa Pountney1, Anne Mandy, Elizabeth Green
1Chailey Heritage Clinical Services, North Chailey, East Sussex, UK. Teresa.Pountney@southdowns.nhs.uk
Insights
Comprehensive postural management, including 24-hour support systems, significantly preserves hip integrity in children with cerebral palsy, preventing dislocation and deformity.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Rehabilitation Medicine
Background:
- Hip dislocation is a common and serious complication in children with cerebral palsy.
- Muscle imbalance around the hip is the primary cause of hip subluxation and acetabular dysplasia.
Purpose of the Study:
- To investigate the impact of various postural management strategies on hip deformity in children with bilateral cerebral palsy.
- To evaluate the effectiveness of 24-hour postural management in preventing hip subluxation and dislocation.
Main Methods:
- Retrospective study of 59 children with bilateral cerebral palsy.
- Analysis of X-rays using Reimers' hip migration percentage.
- Categorization of postural management into three groups based on the use of Chailey Adjustable Postural Support (CAPS) systems.
Main Results:
- Children utilizing a 24-hour postural management approach (all CAPS) demonstrated significantly better hip integrity.
- Early intervention with comprehensive postural management was associated with preserved hip status.
Conclusions:
- Postural management interventions are crucial for preventing hip dysplasia in children with cerebral palsy.
- Consistent and comprehensive application of postural support is key to maintaining hip health.
Background:
Hip dislocation in children with cerebral palsy has a well-documented history and morbidity.
Objective:
This paper presents a retrospective study of children with bilateral cerebral palsy who had various postural management and its effect on hip deformity. The most widely accepted theoretical model of hip subluxation/dislocation is that an imbalance in muscle length and strength around the hip leads to acetabular dysplasia and consequent hip subluxation. Maintenance of muscle length and strength and loadbearing is therefore a logical prevention. Research on normal infants' postures has provided biomechanical data to form the theoretical basis of 24 h postural management equipment.
Methods:
The notes and X-rays of 59 children with bilateral cerebral palsy from East and West Sussex and Oxfordshire were examined and measured to determine whether a relationship existed between postural management and the level of hip subluxation/dislocation. X-rays were measured using Reimers' hip migration percentage. Postural management support was divided into three groups for analysis. Category 1: use of a 24-h postural management approach using Chailey Adjustable Postural Support (CAPS) systems in lying, sitting and standing; category 2: two items of CAPS (either lying/sitting or sitting/standing supports); category 3: use of the CAPS seat only and/or any other postural supports. Hip status was recorded for analysis as both hips safe (under 33% migrated), or one/both hips subluxed.
Results:
Children using 'All CAPS' before hip subluxation maintained significantly more hip integrity than other groups (chi2 P < 0.05).
Conclusions:
Postural management interventions have an important role in the prevention of hip dysplasia.