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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A nonambulatory verbal 6-year-old child with spastic quadriplegic cerebral palsy has progressive bilateral hip subluxation of more than 50%. There is no pain with range of motion, but abduction is limited to 20 degrees maximum. An AP radiograph is seen in Figure 34. Management should consist of
percutaneous bilateral adductor tenotomy.
phenol injection into the obturator nerve.
open adductor tenotomy with neurectomy of the anterior branch of the obturator nerve.
open adductor tenotomy with release of the iliopsoas and bilateral proximal femoral varus derotation osteotomy.
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Figure A exhibits a radiograph of a 19-year-old female with spastic cerebral palsy who meets Gross Motor Functional Classification System 3 criteria. She ambulates with a posterior walker and over the past 8 months reports worsening right hip pain. Her abduction is limited to 30 degrees and she states that her pain worsens with weight bearing. An additional abduction-internal rotation view exhibits a lack of congruency. What is the most appropriate surgical option?
Right proximal femoral varus derotational osteotomy
A 15-year-old, non-ambulatory patient with cerebral palsy who is unable to maintain an upright head position against gravity, has pain while sitting in his wheelchair. An AP pelvis radiograph is shown in Figure A and attempted frogleg lateral view in Figure B. A preoperative CT scan (Figure C) demonstrates significant femoral head flattening. What is the most accurate Gross Motor Function Classification System level, and what is the most appropriate surgical intervention?
GMFCS V: Open reduction with varus derotational osteotomy, femoral shortening, psoas release, and pelvic osteotomy
GMFCS I: Hip adductor and psoas release plus abduction bracing
GMFCS V: Open reduction with varus derotational osteotomy
GMFCS V: Proximal femoral resection
GMFCS I: Open reduction with femoral varus derotational and pelvic osteotomy
The parents of a wheelchair-bound 8-year-old boy with cerebral palsy present with difficulty during diaper changes and with hygiene care. His physical exam demonstrates 5° of hip abduction on the left hip and 15° on the right. An AP pelvis radiograph is shown in figure A. What is the most appropriate treatment?
Bilateral botox injections and physical therapy
Nighttime Pavlik harness
Bilateral abductor release and valgus femoral osteotomies
Bilateral adductor release, varus femoral osteotomies and acetabuloplasties
Observation with repeat radiograph in 6 months