Background: Guided growth by 1 eccentric transphyseal screw has been used to correct lower limb deformities. Pilot animal studies showed encouraging results in producing varus deformity in the proximal femur. The purpose of this study was to report the preliminary results of guided growth surgery to treat spastic hip displacement. Methods: This case series study included consecutive patients who received soft-tissue release and guided growth at the proximal femur from January 2004 to May 2012 with minimal 2-year follow-up. Surgical indications were children with spastic cerebral palsy aged 4 to 10 years, a gross motor function classification system level IV or V, and hip displacement on 1 or both sides. Study outcomes were Reimer’s migration percentage (MP) and the head-shaft angle (HSA). Results: Nine children with 13 spastic displaced hips received surgery at the age of 6.2 years and were followed up for a mean of 45.6 months. The mean MP improved significantly from 52.2% preoperatively to 45.8% at 3 months, 40.3% at 1 year, and 37.1% at 2 years after operation. HSA was unchanged in the first 3 months, and deceased from 173.3 to 166.4 degrees at 1 year (P<0.01) and to 162.7 degrees at 2 years postoperatively. The screw was usually backed out from the femoral epiphysis in the second postoperative year, and no radiologic bony bar or other surgical complications occurred. Conclusions: The immediate postoperative improvement of MP was the result of soft-tissue release. From postoperative 3 months to 2 years, the HSA was reduced by 10.6 degrees and the MP further improved by 8.7%. Less surgical dissection, faster recovery of motion, and less comorbidity than varus osteotomy make guided growth surgery a treatment option for coxa valga in spastic hip displacement in nonambulant cerebral palsy children. Level of Evidence: Level IV—therapeutic, case series.

Calcaneal lengthening is used to correct symptomatic planovalgus foot deformity, but outcomes have been less satisfactory in children with cerebral palsy. This study aimed to define limits of calcaneal lengthening by analyzing the risk factors for undercorrection of deformity. We retrospectively reviewed 20 cases of children with cerebral palsy who underwent calcaneal lengthening of 30 planovalgus feet at a mean age of 11.9 years. Foot deformities were evaluated by the anteroposterior talo–first metatarsal angle (normal, 10 ± 7.0 degrees), lateral talo–first metatarsal angle (normal, 13 ± 7.5 degrees), and lateral calcaneal pitch angle (normal, 17 ± 6.0 degrees) on standing foot radiographs. Among these parameters, a corrected foot was defined as 2 or 3 parameters being corrected to within a normal range, and an undercorrected foot was only 1 or no parameter being corrected to within a normal range. Factors were compared between the corrected group and undercorrected group for significant predictors, and cutoff values of predictors were calculated for use as a clinical guideline. Seventeen planovalgus feet were corrected satisfactorily by calcaneal lengthening, while the other 13 feet were undercorrected. Undercorrected feet had a greater preoperative anteroposterior talonavicular angle (33.7 vs 22.8 degrees, P = .001) and a smaller lateral calcaneal pitch (−1.7 vs 5.6 degrees, P = .03). A talonavicular angle of more than 24 degrees and calcaneal pitch less than −5 degrees were identified as cutoff values using a receiver operating characteristic curve. The predicted probability of undercorrection was 100% (9/9 feet) for 2 positive predictors, 50% (8/16 feet) for 1 positive predictor, and 0 (0/5 feet) for zero predictors. A talonavicular lateral subluxation of more than 24 degrees on the anteroposterior radiograph and a calcaneal pitch angle less than −5 degrees on the lateral radiograph were 2 independent predictors that could be used to identify a planovalgus deformity that would be beyond the corrective capacity of calcaneal lengthening to restore normal alignment. Retrospective case control study, level III

Developmental dysplasia of the hip (DDH) is a preventable and treatable disorder in children. Hip ultrasound is recommended for early detection of affected hips. The timing of the initial hip ultrasound and the frequency of subsequent ultrasounds are controversial topics when considering costs and efficiency. Registry data from the Taiwanese Screening and Audit System for Developmental Dysplasia of the Hip were obtained for biometry of hip ultrasounds using the Graf classification and relevant demographic data from 2016. Initial screening results and final case management outcomes were compared to determine screening accuracy and the number of visits needed to determine final outcomes. In total, we screened 1683 newborns in 2016. Of the initial cases screened within 28 days (n = 1168), 86.6% were negative, 10.1% positive, and 3.3% intermediate, while of the cases screened after 28 days (n = 515), 97.3% were negative, 0.8% positive, and 1.9% intermediate. Screening of the newborns' final hip outcomes revealed that 1641 (97.6%) were negative, treatment was administered in 8 cases (0.4%), and 34 (2.0%) cases were lost to follow-up. When comparing screening times, screening after 28 days improved specificity (89%-97%), and later screenings were associated with fewer visits needed to confirm hip outcomes (aOR = 0.19, CI95% = 0.10-0.38, p < 0.001) and improved accuracy (aOR = 13.84, CI95% = 4.23-45.26, p < 0.001). This study provides evidence of the benefits of screening for DDH after 28 days, namely: reduced false positives, improved screening accuracy, and a reduced requirement for follow-up visits. Delaying screening can also potentially reduce unnecessary parental anxiety, eliminate unnecessary healthcare burdens, and reduce costs. We recommend performing hip ultrasound screening for newborns after 28 days.

Improving motor function is a major goal of therapy for children with cerebral palsy (CP). However, changes in motor function after orthopedic surgery for gait disorders are seldom discussed. This study aimed to evaluate the postoperative changes in gross motor function and to investigate the prognostic factors for such changes. We prospectively studied 25 children with CP (4-12 years) who were gross motor function classification system (GMFCS) level II to IV and and underwent bilateral multilevel soft-tissue release for knee flexion gait. Patients were evaluated preoperatively and at 6 weeks and 3 and 6 months postoperatively for Gross Motor Function Measure (GMFM-66), range of motion, spasticity, and selective motor control. The associations between change in GMFM-66 score and possible factors were analyzed. 25 children with gross motor function level II to IV underwent surgery at a mean age of 8.6 years (range, 4-12 years). Mean GMFM-66 score decreased from 55.9 at baseline to 54.3 at 6-weeks postoperatively and increased to 57.5 at 6-months postoperatively (p < 0.05). Regression analysis revealed better gross motor function level and greater surgical reduction of spasticity were predictors for decreased GMFM-66 score at 6-weeks postoperatively. Younger age was a predictor for increased GMFM-66 score at 6-months postoperatively. Reduction of contracture and spasticity and improvement of selective motor control were noted after surgery in children with CP. However, a down-and-up course of GMFM-66 score was noted. It is emphasized that deterioration of motor function in children with ambulatory ability and the improvement in young children after orthopedic surgery for gait disorders. case series, therapeutic study, level 4.