CP

Talking the talk

• CP is a complex problem that effect the cognition, motor and

sensory function of the patient. This require a comprehensive
treatment and a MDT approach. I will take a detailed history
and examine the patient to establish the level of function, type
of CP, pattern of involvement and walking potential. I will
specifically look for spasticity and deformities associated with
spasticity
 Walking potential
GMFCS

• I: walks unrestricted

• II: restricted walking with out aid

• III: Restricted walking with aid

• IV: Wheel chair bound with good head control

• V: Wheel chair bound with out head control

 Permanent non progressive motor
disorder due to damage in the brain
before birth or with in 2 years of life
 Classification
• Physiolgic

• Spastic

• athetoid: Basal ganglia

• Ataxic: Brain stem

• Mixed

• Anatomic

• Mono

• Diplegia

• Hemiplegia

• tetraplegia
 Cause
• Prenatal

• Infections :TORCH

• Alcohol

• Smoking

• Perinatal

• Prematurity

• Postnatal

• Trauma

• tumor

• infection
 Problems
• Cognitive

• Motor

• Spasticity

• weakness

• lack of coordination

• Sensory
 What Orthopaedic surgeon can
offer

• Can address only spasticity and deformities related to spasticity

• Dynamic contracture

• Fixed contracture

• Fixed contracture with bony changes

 Lower limb and spine
• Scoliosis

• Hip subluxation and dislocation

• Migration index

• Knee flexion deformity

• Hamstring

• Equinous

• Gastro-solus

• Equinovarus

• TPost

• Equinovalgus

• Peroneals

• Crouch gait: Hip and knee flexed with ankle dorsiflexed

• Iliopsoas, hamstring or both contracture

• Ach tendon lengthening

 Upperlimb

• Flexion deformity of hand and fingers

 Scissoring

• Due to adductor spasticity

• Ankle is in plantar flexion

 Philosophy

• Shark attack SEMLS

• Successive procedures, Birthday syndrome

 Hip in CP
• Hip at risk: migration index >15, <40

• Monitor

• adductor tenotomy

• Subluxated hip:

• 40-60: Likely to proceed to dislocation

• >60: require urgent intervention

• Dislocated hip

• U/L

• B/L
 Treatment options
• Preventive

• Adductor release

• Psoas release

• Reconstructive

• Femoral shortening, versioning and derogation osteotomy

• Acetabular osteotomy

• Salvage

• PSO

• Proximal resection
 GMFCS IV and V
• High chance of hip dislocation

• NICE guideline advices screening at 3 years and then yearly

• Aim is to get b/l symmetrical hip and to avoid pelvic tilt

• U/L subluxation/dislocation require B/L procedure

• Treating one side only removes the split to other side and draws
that side out

• Causes pelvic tilt and progressive scoliosis

 Knee

• Popliteal angle

• 135 in ambulatory

• 90-100 in non ambulatory

• Hamstring lengthening and address co-spasticity of quadriceps