gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
51. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

26. - 29.10.2010, Berlin

Accuracy of a new protocol for estimating joint derotation during gait in children with cerebral palsy

Meeting Abstract

Suche in Medline nach

  • H. Böhm - Orthopädische Kinderklinik, Ganglabor, Behandlungszentrum Aschau, Aschau i. Chiemgau, Germany
  • F. Stief - Orthopädische Kinderklinik, Ganglabor, Behandlungszentrum Aschau, Aschau i. Chiemgau, Germany
  • L. Döderlein - Orthopädische Kinderklinik, Behandlungszentrum Aschau, Aschau i. Chiemgau, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 51. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 26.-29.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocIN12-922

DOI: 10.3205/10dkou085, URN: urn:nbn:de:0183-10dkou0855

Veröffentlicht: 21. Oktober 2010

© 2010 Böhm et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Internally rotated gait is the most common movement disorder in patients with cerebral palsy and it is associated with severe functional and cosmetic gait disturbances. Standard orthopaedic treatment is the femoral derotation osteotomy. Instrumented gait analysis can be helpful in identifying the location of lower limb rotational deviations to improve surgical outcome. However the standard Plug-in-Gait protocol (PIG) [1], used by a vast majority of clinical laboratories, does not provide accurate and reliable measures in the transversal planes [2]. Therefore a new protocol (MA) was developed using an additional medial marker at the medial femoral condyle to determine knee joint axis orientation. The MA protocol demonstrated a greater repeatability in the transversal plane than the PIG protocol [3]. However it is not known if the MA protocol reflects the visual observations and clinical findings more accurately. Therefore, the aim of this study was to compare the PIG to the MA protocol regarding the hip rotation angles outcome and compare it to visual observation and clinical findings.

Method: In a prospective study, 41 patients (13(4) years 148(19) cm 42(14) kg) diagnosed with cerebral palsy and rotational deviations of the lower limbs were gait analysed. All parents gave informed consent to participate in this study. Gait analysis was performed using an 8-camera Vicon System (Vicon, UK). Mean hip rotation over the gait cycle was determined with the PIG and the MA protocol. The mean hip rotations of both protocols were compared to clinical presentation, using video footage of sagittal and coronal plane walking and clinical examinations of passive hip joint rotations.

Results and Conclusions: In 52 legs, hip rotation was orientated more internally in MA than in PIG with 18.5(10.1) deg. and 0.7(11.0) deg. internal rotation respectively. This was corroborated by visual analysis and the predicted inward rotation of the clinically measured centre of passive hip rotation of 19.2(12) deg. In 16 legs, hip inward rotation was higher with the PIG model and concurred with a smaller magnitude of passive hip rotation. In 14 legs there were minimal or no differences between PIG and MA.

In the majority of cases, clinical examination and gait analysis with the MA were in better agreement with the visual observations and clinical findings. For patients with cerebral palsy who present rotational deviations of the lower limbs, the new MA protocol appears to be more accurate and therefore clinically relevant for determination of hip rotation, than the conventional PIG protocol.


References

1.
Davis RB, Ounpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Hum Movement Sci. 1991;10:575–87.
2.
McGinley JL, Baker R, Wolfe R, Morris ME. The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture. 2009;29(3):360-9. Epub 2008 Nov 13.
3.
van den Noort JC, Scholtes VA, Harlaar J. Evaluation of clinical spasticity assessment in cerebral palsy using inertial sensors. Gait Posture. 2009;30(2):138-43. Epub 2009 Jun 13.