Neurobionplus
Home About Journal AHEAD OF PRINT Current Issue Back Issues Instructions Submission Search Subscribe Blog    
Login 

Users Online: 588 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
 


 
 Table of Contents    
AUTHORS' REPLY  
Year : 2013  |  Volume : 47  |  Issue : 3  |  Page : 319
Author's reply in response to letter to editor Indian J Orthop 2012;46:602 titled "Utility of combined abduction angle for hip surveillance in children with cerebral palsy"


1 K. J. Somaiya Medical College, Hospital and Research Centre, Orthopaedic Consultant, Mumbai, India
2 Honorary Paediatric Orthopaedic Surgeon, Bombay Hospital Institute of Medical Sciences, and Paediatric Orthopaedic Surgeon, Children Orthopaedic Clinic, Oshiwara, Mumbai, India

Click here for correspondence address and email

Date of Web Publication10-May-2013
 

How to cite this article:
Divecha A, Bhaskar A. Author's reply in response to letter to editor Indian J Orthop 2012;46:602 titled "Utility of combined abduction angle for hip surveillance in children with cerebral palsy". Indian J Orthop 2013;47:319

How to cite this URL:
Divecha A, Bhaskar A. Author's reply in response to letter to editor Indian J Orthop 2012;46:602 titled "Utility of combined abduction angle for hip surveillance in children with cerebral palsy". Indian J Orthop [serial online] 2013 [cited 2020 Feb 22];47:319. Available from: http://www.ijoonline.com/text.asp?2013/47/3/319/111519
Sir,

We thank Meena et al. for his keen interest shown in our article [1] and critically analysing it. [2]

We do appreciate the fallacy of goniometric measurement, but in our study we used a standard protocol and the therapist was trained of taking measurement. In the clinical setting, an average of five readings would probably give us a good estimate of the hip abduction.

We also agree that the false negative rate of 13.9% (CHAA angle was more than 40΀ in 14 children, but the migration was more than 33%) may be high and this is reflected in the sensitivity of the CHAA test. Perhaps, a large study can answer the efficacy of this test. We hope that all children are followed up regularly as certainly the hip abduction will decrease with further migration.

A large review study in 2006 revealed that 60% of all children with cerebral palsy who had not walked by 5 years have had hip subluxation or dislocation. [3] This has been our experience as well. Hence, we recommend that the functional ambulators and non-ambulators (GMFCS V and IV) be followed closely. [4]

Both clinical examination and X-rays are important. No single reading will be reliable, but regular followup of these children showing stiffening in range of motion should alert the person to seek further confirmation. Both clinical examination and radiographs are complementary. The last sentence is very relevant. Very often, children are seen by a therapist who does not order X-rays directly but refers the child to an orthopedic surgeon. To our dismay, even our orthopedic colleagues not dealing with CP children usually treat the child symptomatically without asking for xrays and even checking for range of motion of the hip.

A recent Scandinavian study on CP children showed a high proportion of hip dislocation in children who never had any formal screening. [4] Hence, it may be a good idea to have routine X-rays, but we did not address this issue in our study.

 
   References Top

1.Divecha A, Bhaskar A. Utility of combined 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.Meena S, Ratan R, Lohia L, Raj R. Utility of combined abduction angle for hip surveillance in children with cerebral palsy. Indian J Orthop 2012;46:602.  Back to cited text no. 2
    
3.Gordon GS, Simkiss DE. A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br 2006;88:1492-6.   Back to cited text no. 3
    
4.Elkamil AI, Andersen GL, Hägglund G, Lamvik T, Skranes J, Vik T. Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: A cross sectional study in Sweden and Norway. BMC Musculoskelet Disord 2011;12:284.  Back to cited text no. 4
    

Top
Correspondence Address:
Akshay Divecha
J/21, Vrushali Shilp CHS, Chikuwadi, Borivli (W), Mumbai - 400 092
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions




 

Top
 
 
 
  Search
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
 

 Article Access Statistics
    Viewed642    
    Printed16    
    Emailed0    
    PDF Downloaded43    
    Comments [Add]    

Recommend this journal