KINEMATIC AND KINETIC-ANALYSIS OF DISTAL DEROTATIONAL OSTEOTOMY OF THE LEG IN CHILDREN WITH CEREBRAL-PALSY

Patients with cerebral palsy often develop rotational deformities of t he lower extremities. These deformities may be caused by abnormal musc le tone, soft-tissue contractures, or bony malalignment. When rotation al deformity persists after correction of the soft-tissue components, bony-realignment procedures are warranted to improve gait in ambulator y patients. We performed a retrospective review of 10 ambulatory child ren with cerebral palsy and tibial torsion who underwent 13 distal tib ial and fibular derotation osteotomies. Preoperative and postoperative three-dimensional gait analysis were used to determine the effect of distal tibial and fibular derotation osteotomy on tibial rotation, foo t-progression angle, gait velocity, and moments about the ankle. Mean tibial rotation and foot-progression angle were significantly improved by the procedure. Gait velocity improved but not significantly. Momen t data demonstrated a trend toward normal. This study demonstrates, th at the derotational distal tibial and fibular osteotomy stabilized wit h percutaneous crossed Kirschner wires is a safe, reliable, and effect ive procedure for correcting rotational deformities of the leg in pati ents with cerebral palsy.