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Baby Suffering With Spastic Diplegia And DDH. Treatment ?
Question: my baby suffering with spastic diplegia and DDH. would like to check for treatment.
Hello,
Thanks for posting your query.
DDH with CP (spastic diplegia)is a rare disorder and there are controversies regarding accepting a single procedure as the best way of management . So treatment is always individualized and may consist of trials of complex surgical procedures.
I understand your fears since your child has undergone a prior surgery but unfortunately the dislocation has recurred . This is sometimes seen due to the defects in the development of the hip bones like acetabulum and the spasticity or alteration of the muscular dynamics due to Cerebral palsy.
However considering the age, redislocation as seen on X-ray , history of spasticity and the doctors advice, it's recommended that your child should undergo the operative procedure as advised rather than just wearing an abduction brace.
This is because studies have shown better outcomes for 3-7 year olds with such problem who undergo complex multiple procedures like open reduction with femoral osteotomy , acetabular remodeling and muscle release or reconstructive procedures.
Rather than conservative , bracing and splinting which is advised for DDH without CP the surgery helps in children with diplegia and unilateral dislocation to achieve better limb dynamics and better chances of achieving functional walking .
I am sorry if I am unable to explain any of the technicalities as I am not sure of how well you can understand the medical aspects of the problem and it's treatment.
Yet, hope I have answered your query.
I'll be available for any follow up queries.
Regards
Thanks for posting your query.
DDH with CP (spastic diplegia)is a rare disorder and there are controversies regarding accepting a single procedure as the best way of management . So treatment is always individualized and may consist of trials of complex surgical procedures.
I understand your fears since your child has undergone a prior surgery but unfortunately the dislocation has recurred . This is sometimes seen due to the defects in the development of the hip bones like acetabulum and the spasticity or alteration of the muscular dynamics due to Cerebral palsy.
However considering the age, redislocation as seen on X-ray , history of spasticity and the doctors advice, it's recommended that your child should undergo the operative procedure as advised rather than just wearing an abduction brace.
This is because studies have shown better outcomes for 3-7 year olds with such problem who undergo complex multiple procedures like open reduction with femoral osteotomy , acetabular remodeling and muscle release or reconstructive procedures.
Rather than conservative , bracing and splinting which is advised for DDH without CP the surgery helps in children with diplegia and unilateral dislocation to achieve better limb dynamics and better chances of achieving functional walking .
I am sorry if I am unable to explain any of the technicalities as I am not sure of how well you can understand the medical aspects of the problem and it's treatment.
Yet, hope I have answered your query.
I'll be available for any follow up queries.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Madam,
Thanks for answering my query in a clear and descriptive way. Should be thankful in clearing my doubts. Also doing some research into this once came to know this is a spastic diplegia. Going through web came across multiple ways of procedures in allopathy, homeopathy, physiotherapy and ayurveda. she is able to walk with support and she has difference in length of her both legs.
would be appreciated and greatfull to you if you can answer below questions.
1. which procedure would be best to this kind. if allopathy with surgery is necessary can i go physiotherapy first and surgery next or vice versa.
2. whether i have to consult a orthopaedician or neuro surgen Or both.
3. would you recommend best specialist from Hyderabad who can answer and do well.
I apologize if i am asking unnecessary questions. As I am in a confusion to which way i have to proceed as there was no success in her first open reduction.
Thanks, XXXXXXX .
Thanks for answering my query in a clear and descriptive way. Should be thankful in clearing my doubts. Also doing some research into this once came to know this is a spastic diplegia. Going through web came across multiple ways of procedures in allopathy, homeopathy, physiotherapy and ayurveda. she is able to walk with support and she has difference in length of her both legs.
would be appreciated and greatfull to you if you can answer below questions.
1. which procedure would be best to this kind. if allopathy with surgery is necessary can i go physiotherapy first and surgery next or vice versa.
2. whether i have to consult a orthopaedician or neuro surgen Or both.
3. would you recommend best specialist from Hyderabad who can answer and do well.
I apologize if i am asking unnecessary questions. As I am in a confusion to which way i have to proceed as there was no success in her first open reduction.
Thanks, XXXXXXX .
Hello Mr XXXXXXX XXXXXXX
Thanks for the follow up.
Please do not apologize , you are doing it for your child and infact it's best to be vigilant and well read about health problems as you can take an informed decision.
Answer 1. Allopathy with surgery would be the best option in such a condition as the child has not only spastic diplegia but DDH too. If she has a limb length discrepancy it is mostly due to the dislocation which makes it all the more important to go ahead with the surgery . Yes physiotherapy is a must either before or after surgery . I would advise it to be started as soon as possible to watch for any improvement in the tone of muscles and gait. But that doesn't mean that surgery should be delayed.Even if she had no dislocation , physiotherapy is helpful for treatment of her spastic diplegia.
The final decision should be taken by the treating doctor ( orthopedic surgeon)
Answer 2. Yes you may have to consult both a pediatric orthopedic surgeon ( for DDH)and pediatric neurologist ( for cerebral palsy). In addition you also have to consult a physiotherapist and occupation therapist ( if bracing needed ) but they can be consulted as per your surgeons reference and guidance.
Answer 3. I personally do not know any orthopedic surgeon in Hyderabad as I'm based in Mumbai however I would suggest you go for institutional treatment ( corporate hospital , or govt affiliated educational institutes etc ) where the surgeons are well experienced and you can get all specialists , and facilities under one roof.
Another alternative is to use the find a doctor application on this forum to search for the best suitable doctor in your locality . You can go through a list of doctors their professional details and practicing area to come to a conclusion. Please do not get disheartened by the failure of the first surgery. It's not due to incompetency of doctor but a known complication of such procedure. Infact your reports suggest that you have been to good doctors and received appropriate advice .
Hope I have answered your queries.
Kindly accept my answer if you have no further queries.
I sincerely wish your child a speedy recovery and good health.
Wishing you all the best .
Regards,
Thanks for the follow up.
Please do not apologize , you are doing it for your child and infact it's best to be vigilant and well read about health problems as you can take an informed decision.
Answer 1. Allopathy with surgery would be the best option in such a condition as the child has not only spastic diplegia but DDH too. If she has a limb length discrepancy it is mostly due to the dislocation which makes it all the more important to go ahead with the surgery . Yes physiotherapy is a must either before or after surgery . I would advise it to be started as soon as possible to watch for any improvement in the tone of muscles and gait. But that doesn't mean that surgery should be delayed.Even if she had no dislocation , physiotherapy is helpful for treatment of her spastic diplegia.
The final decision should be taken by the treating doctor ( orthopedic surgeon)
Answer 2. Yes you may have to consult both a pediatric orthopedic surgeon ( for DDH)and pediatric neurologist ( for cerebral palsy). In addition you also have to consult a physiotherapist and occupation therapist ( if bracing needed ) but they can be consulted as per your surgeons reference and guidance.
Answer 3. I personally do not know any orthopedic surgeon in Hyderabad as I'm based in Mumbai however I would suggest you go for institutional treatment ( corporate hospital , or govt affiliated educational institutes etc ) where the surgeons are well experienced and you can get all specialists , and facilities under one roof.
Another alternative is to use the find a doctor application on this forum to search for the best suitable doctor in your locality . You can go through a list of doctors their professional details and practicing area to come to a conclusion. Please do not get disheartened by the failure of the first surgery. It's not due to incompetency of doctor but a known complication of such procedure. Infact your reports suggest that you have been to good doctors and received appropriate advice .
Hope I have answered your queries.
Kindly accept my answer if you have no further queries.
I sincerely wish your child a speedy recovery and good health.
Wishing you all the best .
Regards,
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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