Does screw position matter for guided growth in cerebral palsy hips?

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An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model
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An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Published on: May 31, 2017

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Po-Jen Hsu1, Kuan-Wen Wu2, Chia-Che Lee2

  • 1Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.

The Bone & Joint Journal
|September 1, 2020
PubMed

Insights

Guided growth effectively treats coxa valga in children with cerebral palsy (CP). A more centered screw position improves outcomes and reduces the risk of the physis growing off the screw, avoiding early revision.

Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Cerebral palsy (CP) management

Background:

  • Guided growth is a common treatment for coxa valga in children with cerebral palsy (CP).
  • Optimal screw placement for proximal femoral hemi epiphysiodesis in CP has not been established.
  • Understanding screw position's impact is crucial for treatment efficacy and minimizing complications.

Purpose of the Study:

  • To investigate the influence of screw position on guided growth outcomes for coxa valga in CP children.
  • To compare the effectiveness of medial quarter versus middle quarter screw placement.
  • To identify factors affecting head-shaft angle (HSA) correction and physeal complications.

Main Methods:

  • Retrospective analysis of 61 hips in 32 CP children undergoing proximal femoral hemi epiphysiodesis.
  • Hips divided into medial quarter (Group 1) or middle quarter (Group 2) screw placement groups.
  • Comparison of pre- and postoperative radiographs for HSA, migration percentage (MP), acetabular index (AI), and femoral anteversion angle (FAVA).

Main Results:

  • Group 1 (medial quarter) showed greater HSA and MP reduction but a higher incidence of the physis growing off the screw.
  • Both groups demonstrated similar improvements in AI and FAVA.
  • Regression analysis confirmed screw position eccentricity correlates with HSA correction and physeal complications.

Conclusions:

  • Guided growth effectively corrects coxa valga and excessive femoral anteversion in CP.
  • A more centered screw position (middle quarter) is recommended to avoid early revision, despite potentially reduced varus correction efficacy in younger children.
  • Screw placement significantly impacts treatment outcomes and complication rates in CP hip surgery.
Abstract

Keywords:
Cerebral palsyGuided growthHead-shaft angleScrew position

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