Abstract
Introduction: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons’ current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons.Methods: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children’s orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher’s exact test were used to examine the relationship between two qualitative variables.Results: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items.Discussion: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge–practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons’ educational curricula and an updated health referral system.
Highlights
Ankle equinus is one of the extremely prevalent deformities in cerebral palsy (CP) children [1]
The target population consisted of orthopedic surgeons who were further subcategorized in accordance with practice age, subspecialty – general versus pediatric – and exposure to children’s orthopedic disorders during the last three years of their practice
Participants were asked to respond to the following three demographic questions: (1) You are practicing orthopedics for? (a) less than five years, (b) more than five years; (2) Are you “permanently” attached to a pediatric orthopedic division at a major institution or identify yourself as having 60% of your clinical practice in pediatric orthopedics? (a) Yes, (b) No; (3) Were you exposed to children and adolescents’ disorders during the last three years of your clinical practice? (a) Yes, (b) No Participants were allocated to the pediatric orthopedic subcategory if they chose “yes” as an answer to
Summary
Ankle equinus is one of the extremely prevalent deformities in cerebral palsy (CP) children [1]. Imprecise surgical interventions can aggravate the child’s gait inefficiency This is especially true for the management of ankle equinus. Overlengthening, or poorly selected triceps surae lengthening procedure (as an unnecessary Achilles tendon lengthening) can result in the development of a calcaneus deformity, deterioration of crouch gait with diminished ankle push-off moment. This is usually referred to as iatrogenic or “surgeon-induced crouch,” the pathogenesis of which occurs through insulting the soleus an already overburdened muscle in patients with crouch gait [5,6,9]. It is commonly overlooked by physicians [1,6]
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