1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-05
DISTAL FEMORAL EXTENTSION OSTEOTOMY AND PATELLAR TENDON
ADVANCEMENT IN THE TREATMANT OF CROUCH GAIT: A REVIEW OF
COMPLICATIONS
Novacheck, Tom F., MD, Stout, Jean L., PT, MS, Gage, James R., MD
Gillette Children’s Specialty Healthcare, St. Paul, USA
Summary/Conclusions
The complication rate of patellar tendon advancement (PTA) is higher than that of distal
femoral extension osteotomy (DFEO). The most common complications were different
between the two procedures. Although complications can and do occur, with experience they
can be anticipated, managed, and avoided.
Introduction
A clearer understanding of the dynamics of crouch gait is available today as a result of the
study of typical and pathologic gait using modern motion analysis laboratories. Surgical
advances in the techniques of distal femoral extension osteotomy and distal patellar tendon
advancement have been previously demonstrated to be effective in the treatment of crouch and
restoration of upright ambulation. 1 However the type and rate of complications of these
procedures has not previously been examined. The purpose of this study was to examine the
type and rate of complications associated with each procedure to assist in counseling families
regarding the risks of intervention.
Statement of Clinical Significance
Because of their utility in managing crouch gait, DFEO and/or PTA procedures are becoming a
common treatment recommendation for individuals with persistent crouch gait based on gait
analysis findings. Until experience has been gained, new procedures can have a higher risk of
complications. With practice, they can be anticipated, managed, and avoided. Report of
complications and changes in techniques and care which have resulted are important education
for others that may perform the procedures. Understanding the type and rate of complications
associated with each procedure also enhances the ability to counsel patients and families
regarding the risks of intervention.
Methods
A retrospective medical record review was done of all individuals who had undergone either
DFEO, PTA or combination of the two procedures beginning with the first procedure which
was performed in 1994 and the date chosen to end the study in June 2005. Data from the
surgical admission to the last available outpatient clinic note was reviewed for each case. Any
unwanted event was considered a complication. Short-term complications related to initial
inpatient stay or casting were recorded but not considered as part of this analysis. Complication
types and rates were recorded separately for each procedure in a consecutive manner.
Results
One hundred seventy-one individuals who had undergone one or both procedures were
identified. A total of 205 surgical events were reviewed with 198 DFEO and 249 PTA
performed. Sixty-seven patients were female, 104 were male. Their average age was 15.1±4.9
years (range: 4.6 to 39 years). Cases were performed by a total of eight surgeons. Seventyeight
percent of the cases were performed by two of the authors as first surgeon (50% jrg; 28%
tfn). The majority of procedures were performed between 2000 – 2005 (88% DFEO; 90%
PTA). The type of complications encountered for each procedure is found in Table 1.
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