title: Kinematic and kinetic analysis of distal derotational osteotomy of the leg in children with cerebral palsy.
abstract: Patients with cerebral palsy often develop rotational deformities of the lower extremities. These deformities may be caused by abnormal muscle tone, soft-tissue contractures, or bony malalignment. When rotational deformity persists after correction of the soft-tissue components, bony-realignment procedures are warranted to improve gait in ambulatory patients. We performed a retrospective review of 10 ambulatory children with cerebral palsy and tibial torsion who underwent 13 distal tibial and fibular derotation osteotomies. Preoperative and postoperative three-dimensional gait analysis were used to determine the effect of distal tibial and fibular derotation osteotomy on tibial rotation, foot-progression angle, gait velocity, and moments about the ankle. Mean tibial rotation and foot-progression angle were significantly improved by the procedure. Gait velocity improved but not significantly. Moment data demonstrated a trend toward normal. This study demonstrates that the derotational distal tibial and fibular osteotomy stabilized with percutaneous crossed Kirschner wires is a safe, reliable, and effective procedure for correcting rotational deformities of the leg in patients with cerebral palsy.
authors.affiliation: Children's Hospital and Health Center, San Diego, California, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Stefko
authors.forename: R J
authors.initials: RJ
authors.lastname: de Swart
authors.forename: D A
authors.initials: DA
authors.lastname: Dodgin
authors.forename: M P
authors.initials: MP
authors.lastname: Wyatt
authors.forename: K R
authors.initials: KR
authors.lastname: Kaufman
authors.forename: D H
authors.initials: DH
authors.lastname: Sutherland
authors.forename: H G
authors.initials: HG
authors.lastname: Chambers
mesh_terms: D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000601:surgery*; D005684:Gait; D006801:Humans; D007700:Kinetics; D008297:Male; D010027:Osteotomy; D012189:Retrospective Studies; D012399:Rotation; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D014102:Torsion Abnormality; D016896:Treatment Outcome