The effectiveness of controlled growth in correcting the inequality of the length of the lower extremities in the framework of multi-level simultaneous orthopedic interventions in children with hemiparetic forms of cerebral palsy

Abstract

INTRODUCTION: Multilevel simultaneous orthopedic interventions in hemiparetic cerebral palsy imply correction of orthopedic complications on the involved limb and equalization or reduction of the inequality of the limb length. The effectiveness of correcting the inequality of limb length by controlled growth while improving the function of the involved limb by performing a multilevel orthopedic intervention remains unknown. AIM: To analyze the parameters of correction of the inequality of the length of the segments of the lower extremities using controlled growth in children with spastic hemiplegia in the framework of multilevel orthopedic interventions. MATERIALS AND METHODS: In 24 children with spastic hemiplegia, the results of correction of the inequality of the length of the lower extremities by controlled growth (extraphyseal epiphysiodesis) performed within the framework of multilevel simultaneous interventions were studied. RESULTS: The duration of correction was, on average, 18 months during hip surgery and 18.5 months with growth inhibition in the lower leg. Generally, considering the length of the segments of both the thigh and lower leg, the correction achieved was relatively satisfactory. Preoperatively, the difference in the total length of the thigh and lower leg was 18 mm (11–23), and after the correction period, it was 4 mm (−4.5–5.75). In performing epiphysiodesis before age 11 years, hypercorrection of the shortening of the involved limb may occur, considering the difference in the length of the thigh–shin segment. As age increases at the time of intervention (especially in the second half of puberty), the effectiveness of the controlled growth technique decreases. In all cases, when the correction value was 1 cm, patients’ age exceeded 144 months (12 years). CONCLUSION: Given the advantages of multilevel interventions in cerebral palsy, performing controlled growth within a single operation with reconstructive elements on the involved limb is preferable. The controlled and reversible nature of extraphyseal temporary epiphysiodesis is beneficial in achieving the required correction without high risks of excessive growth inhibition. Performing a controlled growth operation is preferable when the patient is ≤12–13 years old, considering the residual growth potential.