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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
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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
Yeul-Bum Park, MD1;Seong-Ho Kim, MD1;Sang-Woo Kim, MD1;Chul-Hoon Chang, MD1;Soo-Ho Cho, MD1; and Sung-Ho Jang, MD2; 1;Departments of Neurosurgery, 2;Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
HPI - 17yoM with quadriplegic CP GMFCS level 5, with chronic right hip dislocation suffered a mildly displaced R hip intertrochanteric fracture while being positioned. He is very high surgical risk due to seizure d/o, recurrant pneumonia, and Crohn's disease.
How would you treat this?