Tibial derotational osteotomies in two neuromuscular populations: Comparing cerebral palsy with myelomeningocele

R. M. Thompson*, S. Ihnow, L. Dias, V. Swaroop

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Purpose To review the outcomes of tibial derotational oste-otomies (TDOs) as a function of complication and revision surgery rates comparing a cohort of children with myelodysplasia to a cohort with cerebral palsy (CP). Methods A chart review was completed on TDOs performed in a tertiary referral centre on patients with myelodysplasia or CP between 1985 and 2013 in patients aged > 5 years with >2 years follow-up. Charts were reviewed for demographics, direction/degree of derotation, complications and need for re-derotation. Two-sample T-tests were used to compare the characteristics of the two groups. Two-tailed chi-square tests were used to compare complications. Generalised linear log-it models were used to identify independent risk factors for complication and re-rotation. Results The 153 patients (217 limbs) were included. Average follow-up was 7.83 years. Overall complication incidence was 10.14%, including removal of hardware for any reason, with a 4.61% major complication incidence (fracture, deep infection, hardware failure). After adjusting for gender and age, the risk of complication was not statistically significantly different between groups (p = 0.42) nor was requiring rederotation (p = 0.09). The probability of requiring re-derotation was 31.9% less likely per year increase in age at index surgery (p = 0.005). Conclusion With meticulous operative technique, TDO in children with neuromuscular disorders is a safe and effective treatment for tibial torsion, with an acceptable overall and major complication rate. The risk of re-operation decreases significantly in both groups with increasing age. The association between age at initial surgery and need for rederotation should help guide the treatment of children with tibial torsion.

Original languageEnglish (US)
Pages (from-to)243-248
Number of pages6
JournalJournal of Children's Orthopaedics
Volume11
Issue number4
DOIs
StatePublished - 2017

Keywords

  • Cerebral palsy
  • Lever arm disease
  • Myelodysplasia
  • Tibial derotational osteotomy
  • Tibial torsion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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