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Tibial Rotation Osteotomies in a Matched Cohort of Myelodysplasia and Cerebral Palsy Children
Peter J Stasikelis1, Aaron T Creek, Linda I Wack
1Shriners Hospitals for Children, Greenville, SC.
Insights
Children with myelodysplasia (MD) experienced more major complications after tibial rotational osteotomies than children with cerebral palsy (CP). Complications were more frequent in children with MD with less functional ability.
Area of Science:
- Pediatric Orthopedics
- Reconstructive Surgery
- Biomechanical Engineering
Background:
- Children with myelodysplasia (MD) present unique health challenges.
- Tibial rotational osteotomies are surgical procedures to correct bone deformities.
- Comparing complication rates in MD versus cerebral palsy (CP) populations is crucial for surgical outcomes.
Purpose of the Study:
- To compare the frequency of complications in pediatric patients with myelodysplasia (MD) undergoing tibial rotational osteotomies.
- To evaluate if children with MD experience higher complication rates than a matched cohort of children with cerebral palsy (CP).
Main Methods:
- Retrospective chart review of children with MD and CP who underwent tibial rotational osteotomy (1997-2012).
- Matched cohort analysis based on age, BMI, and functional ability (GMFCS levels).
- Defined major complications (nonunion, malunion, infection, hardware failure, decubiti, revision) and minor complications (wound issues).
Main Results:
- Fifteen children with MD (21 osteotomies) and 15 with CP (22 osteotomies) were analyzed.
- Children with MD had a 20% rate of major complications (infected nonunion, malunions requiring revision).
- No major complications were observed in the matched cohort of children with CP.
Conclusions:
- While most children in both groups had good outcomes, children with MD had significantly more major complications.
- Increased complication rates in MD patients correlated with lower functional ability (GMFCS IV).
- Further research into optimizing surgical outcomes for pediatric MD patients is warranted.
Background:
The purpose of this study is to examine the frequency of complications in children with myelodysplasia (MD) undergoing tibial rotational osteotomies with a matched cohort of children with cerebral palsy (CP). It was postulated that because of the unique health issues facing children with MD more complications would be observed.
Methods:
A retrospective chart review was performed to identify children with MD who underwent primary tibial rotational osteotomy between 1997 and 2012 and had a minimum 2-year follow-up. The 15 children thus identified were matched for age, body mass index, and functional ability with 15 children with CP. Outcome measures were complications that occurred within a year of osteotomy or hardware removal. Major complications were defined as nonunions or malunions, hardware failures, deep infections, fractures, and stage III or IV decubiti. Recurrence of rotational deformity requiring revision osteotomy at any time was also defined as a major complication. Minor wound problems healing within 6 weeks with only local care were considered minor complications.
Results:
Fifteen children with MD, who underwent 21 tibial derotational osteotomies, were available for review with a mean 7-year follow-up. The 15 children with CP underwent 22 tibial derotational osteotomies with a mean of 6 years of follow-up. In each cohort there were 3 children classified as GMFCS I, 3 children as GMFCS II, 4 children as GMFCS III, and 5 as GMFCS IV. Three (20%) of the children with MD experienced major complications (1 infected nonunion and 2 children who experienced bilateral malunions requiring revisions). One child with a major complication was classified as GMFCS II and the other 2 as GMFCS IV. None of the children with CP experienced a major complication.
Conclusions:
The majority of children in both groups experienced good results, but children with MD have more frequent major complications. More frequent complications were seen in children with less functional ability.
Level Of Evidence:
Level III-prognostic study, case-control study.
