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 Table of Contents    
LETTER TO EDITOR  
Year : 2012  |  Volume : 46  |  Issue : 5  |  Page : 602
Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy


1 Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
2 Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

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Date of Web Publication17-Sep-2012
 

How to cite this article:
Meena S, Ratan R, Lohia L, Raj R. Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy. Indian J Orthop 2012;46:602

How to cite this URL:
Meena S, Ratan R, Lohia L, Raj R. Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy. Indian J Orthop [serial online] 2012 [cited 2019 Sep 16];46:602. Available from: http://www.ijoonline.com/text.asp?2012/46/5/602/101053
Sir,

We read with interest the article titled "A utility of combined hip abduction angle for hip surveillance in children with cerebral palsy" by Divecha and Bhaskar. [1] We have a few comments for the authors and readers:

Inter-examiner reliability regarding the goniometric measurement of hip abduction in children with CP is low. Therefore, goniometric measurements should be used cautiously when taking decisions, especially if no standardized protocols have been followed or no coordination/training session has been organized. [2]

Fourteen children with CHAA >40° had MP >33% on one or both sides. The authors considered it insignificant and assumed it to be due to variation in passive stretching between observers. However, it cannot be considered insignificant as it constitutes 13.59% of the study group.

The authors recommend CHAA of 40° to be taken as the threshold for orthopedic referral and imaging of hips to rule out hip lateralization. It is not clear in the manuscript whether this recommendation is for all patients of cerebral palsy or only for non-ambulators (children in GMFCS 4 and 5).

Measurement of the range of motion is a poor indicator of risk and cannot replace radiographic examinations for hip screening. [3]

It is of utmost importance that children with CP are identified early and that children at risk are examined radiographically as early as possible. Scrutton and Baird recommended that children with spastic diplegia or quadriplegia should have a first radiograph at age 30 months. [4]

 
   References Top

1.Divecha A, Bhaskar A. Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy. Indian J Orthop 2011;45:548-52.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Herrero P, Carrera P, García E, Gómez-Trullén EM, Oliván-Blázquez B. Reliability of goniometric measurements in children with cerebral palsy: A comparative analysis of universal goniometer and electronic inclinometer. A pilot study. BMC Musculoskelet Disord 2011;12:155.  Back to cited text no. 2
    
3.Hägglund G, Lauge-Pedersen H, Wagner P. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 2007;8:101.  Back to cited text no. 3
    
4.Scrutton D, Baird G. Surveillance measures of the hips in children with bilateral cerebral palsy . Arch Dis Child 1997;76 : 381-4.  Back to cited text no. 4
    

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Correspondence Address:
Sanjay Meena
Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.101053

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1 Authoręs reply in response to letter to editor Indian J Orthop 2012;46:602 titled Ā«utility of combined abduction angle for hip surveillance in children with cerebral palsyĀ»
Divecha, A. and Bhaskar, A.
Indian Journal of Orthopaedics. 2013; 47(3): 319
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