title: Neurological complications after supracondylar femoral osteotomy in cerebral palsy.
abstract: BACKGROUND
  Knee flexion contracture in children with cerebral palsy (CP) is very common and functional impairment leads to a crouch gait. Correction of the knee flexion contracture and improvement of the gait pattern by supracondylar femoral extension osteotomy seems to be a more effective method than distal hamstring procedures in long-standing severe crouch. Only a small number of publications reported the neurological complications of this surgical technique. This study was planned to identify the risk factors leading to neurological complications after supracondylar femoral extension osteotomy in patients with CP.
  
  
  METHODS
  Supracondylar femoral osteotomies performed for a primary diagnosis of CP with rigid knee flexion deformity of 10 to 30 degrees were included in the study. Supracondylar femoral extension osteotomy was performed in 28 patients (total: 48 cases). Neurological complication was not detected in 43 cases (group 1) and detected in 5 cases (group 2). Previous surgical operation, concomitant operations on the same extremity, application of a brace or long leg cast after operation, preoperative and postoperative popliteal angle, amount of correction, radiologic correction, tourniquet time, level of malnutrition, and emotional state were reviewed.
  
  
  RESULTS
  There were 18 boys and 10 girls. The mean age was 12±4 years in group 1 and 13±1 years in group 2. Except 6 patients, all patients had concomitant operations (38 cases in group 1 and 4 cases in group 2). Postoperatively, long leg cast was used in 38 cases and brace in 10 cases. In group 1 mean correction was 23±3.8 degrees and in group 2 it was 19±5.7 degrees.
  
  
  CONCLUSIONS
  Correlation was not found between the incidence of neurological complications and amount of correction and deformity. After supracondylar femoral extension osteotomy, all patients must be suspected of neurological complication, and measures taken to alleviate the stretch at once if nerve palsy is diagnosed.
  
  
  METHODS
  Level IV.
authors: *Department of Orthopedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul †Department of Orthopedics and Traumatology, Muş State Hospital, Muş ‡Department of Orthopedics and Traumatology, Şirnak State Hospital, Şirnak, Turkey.
authors: Muharrem
authors: M
authors: İnan
authors: İlker Abdullah
authors: İA
authors: Sarikaya
authors: Enis
authors: E
authors: Yildirim
authors: Mehmet Fatih
authors: MF
authors: Güven
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D000293:Adolescent; D001915:Braces; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005269:Femur / Q000601:surgery*; D005684:Gait / Q000502:physiology*; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology*; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000150:complications; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D058971:Tenotomy; D016896:Treatment Outcome