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J Korean Med Assoc > Volume 51(5); 2008 > Article
Kim and Kwak: Musculoskeletal Surgeries for Optimization of Ambulation Ability in Patients with Spastic Cerebral Palsy

Abstract

Cerebral palsy is a disorder of movement and posture that arises from a congenital or acquired lesion of the immature brain. While the underlying cause is static, the musculoskeletal manifestations are progressive overtime. A variety of gait abnormalities are common, and orthopedic surgery typically is indicated when contractures or deformities decrease functions, cause pain, or interfere with activities of daily life. Surgical procedures should be scheduled to minimize the number of hospitalizations and interference with school and social activities. They can be divided into several groups of procedures; (1) to correct static or dynamic deformity, (2) balance muscle power across a joint, (3) reduce spasticity, and (4) stabilize uncontrollable joints. The clinical decision-making paradigm, consisting of clinical history, physical examination, diagnostic imaging, quantitative gait analysis, and examination under anesthesia makes it possible for single stage multi-level surgeries to reduce the long-term morbidity.

References

1. Sussman MD, Aiona MD. Treatment of spastic diplegia in patients with cerebral palsy. J Pediatr Orthop 2004;13:S1-S12.

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Figure 1
Lever-arm dysfunctions at the hip, knee, and the foot produce hip dislocation, patellar alta, and pathologic flatfoot, respectively.
jkma-51-475-g001-l.jpg
Figure 2
Findings of gait analysis include temporospatial, kinematic, kinetic, and electromyographic parameters.
jkma-51-475-g002-l.jpg
Figure 3
Younger child with spastic diplegia. He walks on his toes in equinus with extended hips and knees.
jkma-51-475-g003-l.jpg
Figure 4
Calcaneal deformity caused by excessive lengthening of the Achilles tendon.
jkma-51-475-g004-l.jpg
Figure 5
Genu recurvatum gait is generally secondary to pes equinus and incompetent ankle plantarflexion-knee extension couple.
jkma-51-475-g005-l.jpg
Figure 6
A child showing jumping gait pattern with hips, knees, and ankles in flexion. The patient needs to hold hands or use a walker, and rarely they can balance themselves.
jkma-51-475-g006-l.jpg
Figure 7
Crouch gait is characterized by increased knee and hip flexion with ankle dorsiflexion.
jkma-51-475-g007-l.jpg
Figure 8
Malalignment syndrome consisting of increased femoral anteversion and external tibial torsion forcing the feet into valgus.
jkma-51-475-g008-l.jpg
Figure 9
Planovalgus foot deformity.
jkma-51-475-g009-l.jpg
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