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  • Cadera Espástica en Parálisis Cerebral Tabla GMFCS

    Enviado por

    Elsa Ivon Perez Flores
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    This document discusses the management of hip displacement in cerebral palsy patients. It finds the risk of hip displacement increases with higher levels on the Gross Motor Function Classification System (GMFCS), from 1% for level I to 90% for level V. Surgery is usually not required for level I patients but may be for levels II-V to address gait, hip stability, sitting ability, and pain issues. The success rate of hip adductor surgery decreases the higher the GMFCS level, from near 90% success at 12 years for level II to much lower rates for levels IV and V.

    Descrição original:

    Clasificación de la cadera espástica en parálisis cerebral según el nivel de función motora gruesa

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    Cadera Espástica en parálisis cerebral Tabla GMFCS

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    This document discusses the management of hip displacement in cerebral palsy patients. It finds the risk of hip displacement increases with higher levels on the Gross Motor Function Classification System (GMFCS), from 1% for level I to 90% for level V. Surgery is usually not required for level I patients but may be for levels II-V to address gait, hip stability, sitting ability, and pain issues. The success rate of hip adductor surgery decreases the higher the GMFCS level, from near 90% success at 12 years for level II to much lower rates for levels IV and V.

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    © All Rights Reserved
    Baixe no formato PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    150 visualizações2 páginas

    Cadera Espástica en Parálisis Cerebral Tabla GMFCS

    Enviado por

    Elsa Ivon Perez Flores
    This document discusses the management of hip displacement in cerebral palsy patients. It finds the risk of hip displacement increases with higher levels on the Gross Motor Function Classification System (GMFCS), from 1% for level I to 90% for level V. Surgery is usually not required for level I patients but may be for levels II-V to address gait, hip stability, sitting ability, and pain issues. The success rate of hip adductor surgery decreases the higher the GMFCS level, from near 90% success at 12 years for level II to much lower rates for levels IV and V.

    Direitos autorais:

    © All Rights Reserved
    Baixe no formato PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    de 2

    Management of Hip Displacement in Cerebral Palsy

    GMFCS Incidence Proximal Femoral Geometry3 Impairment Long-term issues Surgical Intervention
    GMFCS Level I Same incidence as the Usually not required
    rest of population

    GMFCS Level II Diplegia - 15%, slowly Deterioration in Pain and joint Surgery for gait correction
    progressive walking degeneration May include:
    adductor lengthening, FDO +/-
    Hemiplegia (WGH IV4) -
    varus
    1%, develops slowly &
    may occur late

    GMFCS Level III Deterioration in Pain and joint Surgery for gait correction and
    40% walking degeneration hip stability
    Adductor release +/- phenol,
    VDRO
    (+/- procedures at knee and
    foot/ankle to address gait)

    GMFCS Level IV Deterioration in Pain & joint Surgery for sit-to-stand ability
    70% standing, walking degeneration, loss and sitting
    and sitting of standing ability Preventive: adductors + phenol
    posture Reconstructive: VDRO
    (foot stabilization for some)

    GMFCS V Deterioration in Pain & joint Surgery for comfort and care
    90% sitting posture dislocation, loss of Preventive: adductors + phenol
    sitting ability, Reconstructive: VDRO +/- PO
    difficulty with care Salvage: Excision, valgus
    and hygiene osteotomy

    Abbreviations: FNA, Femoral neck anteversion; MP, migration percentage; NSA, neck shaft angle; WGH IV, Winters Gage & Hicks Type IV; FDO, femoral derotation osteotomy; VDRO,
    varus derotation osteotomy; PO, pelvic osteotomy

    Graham, Thomason & Willoughby, Royal Childrens Hospital, Melbourne; Management of Hip Displacement in Children with Cerebral Palsy;
    Risk of Hip Displacement by GMFCS2

    90
    80
    70
    Incidence (%)

    60
    50
    40
    30
    20
    10
    0
    I II III IV V
    GMFCS Level

    Hip adductor surgery success by GMFCS5


    100%
    90%
    80%
    Surgery "success"

    70%
    60%
    50%
    40%
    30%
    20%
    10%
    0%
    0 12 24 36 48 60 72 84 96 108 120 132 144 156
    Time after surgery (months)

    References:
    1. Palisano R, Rosenbaum P, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev
    Med Child Neurol, 1997; 39:214-23.
    2. Soo B, Howard J, et al. Hip displacement in cerebral palsy. JBJS-A, 2006; 88:121-129.
    3. Robin J, Graham H K, et al. Proximal femoral geometry in cerebral palsy. JBJS-A, 2008; 90: 1372-1379.
    4. Winters TF, Gage JR, et al. Gait patterns in spastic hemiplegia in children and young adults. JBJS-A, 1987; 69:437-41.
    5. Shore BJ, Yu X, Desai S, et al. Adductor surgery to prevent hip dislocation in children with cerebral palsy. The predictive role of the Gross
    Motor Function Classification System, JBJS-A 2012; 94:326-334.

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