INSTITUTO DE ORTOPEDIA INFANTIL ROOSEVELT. Dr José Luis Duplat Dr Iván Carlos Uribe Dr Luis Eduardo Rueda
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1 INSTITUTO DE ORTOPEDIA INFANTIL ROOSEVELT Dr José Luis Duplat Dr Iván Carlos Uribe Dr Luis Eduardo Rueda
2 Staff of the Lab Terapist Claudia Gonzalez Magda Baquero Edna Perez Ing Jorge Puentes Elsy Rodriguez Secretary Esperanza Mesa Pediatric Orthopaedic Surgeons Luis Eduardo Rueda Jose Luis Duplat Martha Valencia Ivan Carlos Uribe
3 Equipment BTS ELITE 6 optoelectronic cameras 3 video cameras 2 AMTI force platforms, fixed on floor. Free EMG Baropodography
4 Equipment ELITE Clinic, Smart Tracker V1.0 MyoLab Digivec FileMaker Pro Network Protocol: Davis Working in Upper Limb: Rab Foot protocol 3 4 patients / day
5 Problems in the Lab Digivec software Free EMG config Work with platforms.dbt files,.tdf files
6 Effect of TRAMA project Research other fields than just gait Learning to use software we have Smart Analyzer Avoid square thinking
7 Hip extension osteotomy Lower limb multilevel surgery is used in cerebral palsy walking patients. Poor improving with: Sometimes worse after surgery. Hip flexion deformity. Anterior pelvic tilt.
8 Hip extension osteotomy Looking a modification in intertrochanteric osteotomy (2004) = add an extension effect. We want to evaluate the results with this technique up to now compared with the traditional intertrochanteric proximal femoral osteotomy.
9 Technique
10 Multilevel surgery (Proximal femur intertrochanteric rotation osteotomy) PREOP POSTOP
11 Multilevel surgery (Proximal femur intertrochanteric rotation osteotomy) PREOP POSTOP
12 QUESTION Is more effective the proximal femur extension osteotomy rather than the proximal femur rotation osteotomy to improve the hip flexion deformity in patients with cerebral palsy comparing Davis protocol parameters in gait analysis?
13 Selection criteria Patients with spastic cerebral palsy Be able to walk Previous proximal femur intertrochanteric surgery to improve hip flexion deformity Without intrapelvic psoas tenotomy
14 What we expect: Obtain a better active and pasive hip extension. Improve the pelvic tilt with extension osteotomy that let us to recomend the use to treat this deformity in cerebral palsy patients who are able to walk.
15 GENERAL AIM Evaluate the effect of the proximal femoral extension osteotomy to improve the hip flexion deformity, using the clinical evaluation and gait analisys in patients with spastic cerebral palsy treated at Roosevelt Institute since 2004.
16 SPECIFIC AIM 1- Determinate the clinical improvement in hip flexion deformity meassuring preop and postop results 2- Kinetic and Kinematic pelvic and hip behavior preop and postop using the HFI ( Hip Flexor Index ) Rango tilt pelvico Tilt pelvico maximo Max extension cadera Tiempo crossover (momento) Poder H3
17 SPECIFIC AIM 3 Evaluate the changes in time and distance parameters with both surgery techniques 4 Deteminate if this correction obtained with this technique last in time. 5 Describe a surgical technique been able to reproduce it as an alternative to treat hip flexion deformity in patients with cerebral palsy.
18 TYPE OF STUDY Descriptive Case series comparation
19 DATABASE KINEMATICS
20 DATABASE KINETICS Cross Over Potencia de flexores
21 PRELIMINARY RESULTS
22 THOMAS SIGN AVERAGE RIGHT HIP: PREOP: 18 DEGREES POSTOP: 10.5 DEGREES LEFT HIP: PREOP: POSTOP: 12.85
23 PELVIC TILT AVERAGE Right hip: Preop:19 Postop:15.4 Left hip: Preop:20.3 Postop:15.6
24 Multilevel surgery (Intertrochanteric rotation osteotomy) PREOP POSTOP
25 Multilevel surgery (Intertrochanteric extension osteotomy) PREOP POSTOP
26 Multilevel surgery (Intertrochanteric extension osteotomy) PREOPERATORIO POSTOPERATORIO
27 Working plan Complete data collection of the already included patients Increase the number of patients Apply the hip flexor index once completed the number of patients included.
28 Other Projects Ground reaction force vector Amputees Flat foot orthoses Upper limb Foot patology (Pes cavus, Talipes equinovarus) Foot alignment device Muscle length OpenSim Technical protocols
29 THANK YOU
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