Orthopaedic Surgery for Cerebral Palsy Flashcards
What are the common kinds of orthopaedic surgery used in the management of cerebral palsy?
- Contracture release e.g. hip flexors, adductors, hamstrings, calves
- Tendon transfers e.g. split tibialis posterior, rectus femoris
- Bony
- Epiphyseodesis
When is the suggested timing for hip adductor release and calf lengthening?
Hip adductor: early in response to hip surveillence findings
Calf: when no longer responding to BTX-A, serial casting and orthotics
What are the consequences of over lengthening?
Resultant crouch gait
What is a SEMLs?
Single event multilevel surgery
What patients are SEMLs mostly directed at?
Type III & IV hemiplegics and diplegics who have predominantly spastic not athetoid movements
What are the aims of SEMLs?
- Correct deformity
- Improve ‘lever arm dysfunction’
- Improve gait pattern
- Reduce the energy cost of walking
When is the ideal timing for SEMLs?
Pre-pubertal growth spurt
How many surgeries can be undertaken as part of a SEMLs?
Up to 16 combined soft tissue and bony surgeries
Who is the ideal candidate for SEMLs?
Independent walker, compliant, well-motivated, supported
What methods of immobilisation are used after SEMLs?
- Hip spica
- Broomstick casts
- Zimmer splints
- SL plasters
What components are involved in post-surgery physiotherapy?
- Positioning and plaster care, including pressure areas
- Chest check
- Maintaining muscle length
- Strengthening of gluts, hamstrings and quads
- Early knee flexion
- Transfer practice
What are the possible complications of surgery?
- Under or over correction of long bone torsion
- Over lengthening of muscles
- Nerve traction injuries
- Pressure sores
