Role Of Orthopedic Surgery In Cp

Role of orthopedic surgery Decision more important than incision

Orthopedic surgery Avoid birthday syndrome SEMS single event multiple surgery Good results if A) age appropriate done particularly during growth spurt B) balance at least must be able to kneel. C) cognition must be able to understand reasoning behind the programme and the instructions given. D) disability must have sufficient strength and control that when joints are realigned and soft tissues released the child would be able to benefit fro surgery. E) emotion must be sufficiently mature to be able to undergo the stress involved in extensive surgery and rehabilitation which may last 6 months to a year.

Orthopedic surgery Procedures to lengthen contracted myotendinous units, Balance joint forces, Transfer motor power, Fuse unstable joints, (arthrodesis) Correct bony deformity, (to improve biomechanical alignement) Reduce joint subluxation and dislocation (to improve joint congruety) Diminish painful spasticity Maintain ,restore or stabilise spinal deformity.Procedures only if progressive deformity producing paiin or interfering with function, fixed contracture ,joint subluxation or dislocation, refractory spinal deformity, and deformity preventing adequate administration of care.

Orthopedic surgery Procedures areNeurectomy, tenotomy, Arthrodesis,osteotomy, ostectomy, Tendon transfer, tendon tenthening, Fractional myotendinous lengthening, Multisegmental spinal fusion or a combination of these procedures.

Orthopedic surgery Soft tissue surgeries around 6-7 years of age, unless hip is subluxating then early. Bony surgeries around 10 years and more. Lever arm dysfunctions adressed at that time. Good results in children with spasticity, prognosis guarded with those with mixed cerebral palsy or those with involuntary movements. To improve gait pattern in the ambulatory child To achieve good sitting in the child who is household walker To achieve perenial hygeine in those who have difficulty for nursing, positioning

Orthopedic surgery Oga/or gait analysis done, pci done with without aids At hip pelvic and femoral osteotomies, generally vdro varus derotation osteotomy for internal rotation deformity, ilio-psoas release, adductor tenotomy anterior branch neurectomy, rectus release, rectus transfer to it band, surpacondylar extension osteotomy Medial and lateral hamstring release Supramalleolar tibial osteotomies. Tendoachilles lenthening, peronei release,tib ant,tib post transfer, grices extra articular arthrodesis. Adductor hallucis release, metatarsal osteotomies, arthrodesis

Orthopedic surgery In upper limb lengthening of pectoralis major,or subscapularis tendons, or both,transfer of lattissimus dorsi and teres major to lateral humerus,humeral osteotomy, Brachialis fractional lengthening,zplasty of biceps, flexor-pronator slide, release of elbow capsule.

Orthopedic surgery Pronator tenotomy, lengthening, Rerouting of pronator teres, Pronator flexor slide, Fcu transfer 4th metacarpal, (to finger extensors, Proximal row carpectomy, Release of adductor pollicis, first dorsal interosseus or both, transfer of adductor insertion to the metacarpal, lengthening or reinforcement of flexor pollicis longus, Plication, rerouting, or reinforcement of the extrinsic thumb extensors and abductors.

Orthopedic surgery Spinal stabilizations in children/adults with neck, back pain, scoliosis,(25% in c.p, 60-75% in those with tbi) kyphosis,radiculopathy especially those with athetosis, dystonia.