A prospective study on transfer of pronator teres to extensor carpi radialis brevis for forearm and wrist deformity in children with cerebral palsy

2020 ◽  
pp. 175319342096033
Author(s):  
Gobinder Singh ◽  
Vivek Singh ◽  
Sabeel Ahmad ◽  
R. B. Kalia ◽  
Shobha S. Arora ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Pronator Teres ◽  
Upper Limb Function ◽  
Children With Cerebral Palsy ◽  
Group 2 ◽  
A Prospective Study ◽  
Extensor Carpi Radialis ◽  
Manual Ability Classification System

We prospectively evaluated the clinical and functional outcomes of pronator teres to extensor carpi radialis brevis transfer in children with cerebral palsy. Patients were followed-up at 6 months postoperatively, and functionally assessed using the House classification, Manual Ability Classification System (MACS) and Upper Extremity Functional Index (UEFI). Fifteen children with a mean age of 8.1 years underwent tendon transfers. All patients were of Gschwind and Tonkin Grade 2 for pronation deformity; eight patients were of Zancolli’s classification Group 1 and seven, Group 2 for wrist flexion deformity. The average gain in active supination was 67°, and wrist extension 15°. An increase of 7.0 in the UEFI score was recorded, although no significant improvement in MACS and House classification was observed. We conclude that the pronator teres to extensor carpi radialis brevis transfer improves upper limb function through effective correction of forearm pronation and wrist flexion deformities. Level of evidence: II

Pronator teres selective neurectomy in children with cerebral palsy

2018 ◽  
Vol 43 (8) ◽  
pp. 879-884 ◽  
Author(s):  
Marion Helin ◽  
Manon Bachy ◽  
Claire Stanchina ◽  
Frank Fitoussi
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin Injection ◽  
Hand Function ◽  
Global Strategy ◽  
Level Of Evidence ◽  
Pronator Teres ◽  
Upper Limb Function ◽  
Children With Cerebral Palsy ◽  
Selective Neurectomy

The objective of this study was to evaluate the results after selective pronator teres (PT) neurectomy in children with spastic hemiplegia. Patients with PT spasticity without contracture and an active supination improvement after PT botulinum toxin injection were included. Hand function and deformities were evaluated with the House score, Gschwind and Tonkin pronation deformity classification and Zancolli’s classification. Twenty-two patients (mean age 11.6 years) were included in this study. The average follow-up was 32.6 months. All but one patient improved their supination with a preoperative mean active supination of 5° (range −80–70°) and postoperative of 48° (range 10–90°). Active pronation was always maintained at the last follow-up. PT selective neurectomy appears to improve active and passive forearm supination and should be included in a global strategy of treatments to improve upper limb function in children with cerebral palsy. Level of evidence: IV

scholarly journals Surgical treatment outcome of wrist flexion contracture in children with cerebral palsy through temporary extra-articular arthrodesis

2020 ◽  
Vol 8 (3) ◽  
pp. 281-292
Author(s):  
Vladimir A. Novikov ◽  
Valery V. Umnov ◽  
Dmitry V. Umnov
Keyword(s):  
Cerebral Palsy ◽  
Comparative Analysis ◽  
Surgical Treatment ◽  
Wrist Joint ◽  
Flexion Contracture ◽  
Wrist Flexion ◽  
Children With Cerebral Palsy ◽  
Group 2 ◽  
Temporary Arthrodesis ◽  
Group 1

Background. The surgical approaches adopted for the treatment of wrist flexion contracture can be categorized into soft tissue intervention (such as lengthening or transplantation of tendons) and bone operations that stabilize the wrist joint. We developed a technique for temporary arthrodesis of the wrist joint to combine the main advantages of both the approaches, that is, the stability of arthrodesis by the installed metal construction and the possibility of active movements in the wrist joint after removal of the structure. Aim. To compare the effectiveness of a new method of surgical treatment of wrist flexion contracture in children with cerebral palsy, such as temporary extra-articular arthrodesis and transplantation of the hand flexors to the extensors, according to Green. Materials and methods. We conducted a comparative analysis of the treatment outcomes between the following 2 groups of patients: group 1 (n = 13) patients underwent a tendon transplantation of m. flexor carpi ulnaris on m. extensor carpi radialis brevis/longus (Green operation), while group 2 (n = 13) patients underwent temporary arthrodesis of the wrist joint with a bone plate for a period of 1 year. The patients in group 2, after the removal of metal structures, underwent a 14-day course of rehabilitation before evaluation of their treatment outcomes. A comparative analysis of the treatment results between the groups 1 and 2 was performed 1 year after arthrodesis and plate removal and at 1 year after muscle transplantation. The range of active and passive movements in the wrist joint was analyzed throughout. In addition, the functionality of the upper limb was assessed with reference to the international classification system of MACS 2002 and the Block and Box test. Results. In the group 1 patients, an increase in the passive range of motion (+9.7) was noted. In both the groups, a significant increase was recorded in the amplitude of active movements (31.9 in group 1 and 45.7 in group 2). The upper limb functionality index MACS, on evaluating the condition of the arm as a whole, appeared to be almost identical in both the groups. In the group 1 patients, the average dynamics of the Block and Box test as a result of treatment was 8 additional cubes, while it was only 1.6 in the group 2 patients. Conclusion. The Green operation was less effective in comparison with the operation of temporary arthrodesis as a method of correcting the flexion contracture of the wrist joint. However, the functional performance of the Green operation was higher. The choice of the optimal surgical treatment technique can be determined as follows. In children with a high functional perspective, the Green operation is preferred. However, in children with doubtful functional prospects where the correction of severe contracture is the main aim, temporary arthrodesis may be preferable.

scholarly journals Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

2021 ◽  
pp. 1-9
Author(s):  
Robert M. Kay ◽  
Kristan Pierz ◽  
James McCarthy ◽  
H. Kerr Graham ◽  
Henry Chambers ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Rectus Femoris ◽  
Delphi Consensus ◽  
Level Of Evidence ◽  
Modified Delphi ◽  
International Panel ◽  
Children With Cerebral Palsy ◽  
Stiff Knee ◽  
Paediatric Orthopaedic ◽  
Gmfcs Level

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

scholarly journals An evidence-based review of hyperbaric oxygen for children with cerebral palsy

2001 ◽  
Vol 57 (4) ◽  
pp. 21-22
Author(s):  
F. M. Bischof
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Motor Function ◽  
Controlled Trial ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Children With Cerebral Palsy ◽  
High Level

This paper reviews the evidence in the literature for the use of hypebaric oxygen (HBO) in the treatment of cerebral palsy (CP). To date there are only two published studies on the outcome of HBO administration in CP. A pilot study showed significant improvement in gross motor function but provided a low level of evidence. A recent multicentre, double blind, placebo controlled trial reported similar improvements in both HBO and placebo groups, but no difference between the groups. This study had a high level of evidence. The results suggest that participation in the trial produced clinically important gains in function. The outcome of the study implies that HBO may have a placebo effect in CP.

scholarly journals Stability of the Manual Ability Classification System in young children with cerebral palsy

2019 ◽  
Vol 61 (7) ◽  
pp. 798-804 ◽  
Author(s):  
Andrea Burgess ◽  
Roslyn Boyd ◽  
Jenny Ziviani ◽  
Mark D Chatfield ◽  
Robert S Ware ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Young Children ◽  
Classification System ◽  
Children With Cerebral Palsy ◽  
Manual Ability Classification System

scholarly journals The Effects of Vibration and Pressure Treatments in the Early Postoperative Period of Rhinoplasty

2019 ◽  
Vol 40 (6) ◽  
pp. 605-616 ◽  
Author(s):  
Süleyman Taş
Keyword(s):  
Postoperative Period ◽  
Early Postoperative Period ◽  
Control Group ◽  
Level Of Evidence ◽  
Vibration Treatment ◽  
The Face ◽  
Anti Inflammatory ◽  
Group 2 ◽  
A Prospective Study ◽  
Nasal Cast

Abstract Background The early postoperative period can be distressing for the patients undergoing rhinoplasty since edema and ecchymosis are common complications. Objectives To analyze the effects of the vibration and pressure treatments in the early postoperative period of rhinoplasty. Methods Sixty patients, who had undergone rhinoplasty, were randomized into 3 groups: group 1 (control group, n = 20) received classic nasal casting, group 2 (n = 20) received nasal cast with an elastic bandage to hold it on the face, and group 3 (n = 20) received vibration treatment in addition to that in group 2 following the rhinoplasty. They were evaluated preoperatively and postoperatively at 3 and 7 days in a prospective study. The postoperative edema and ecchymosis were scored by 2 independent surgeons. The postoperative pain was measured using the visual analog scale, and the necessity of anti-inflammatory medication (and the dose needed) and the cast comfort was questioned. The sebaceous activity of the nose skin was examined. A preoperative and postoperative seventh day sonographic study was performed to evaluate the tissue edema objectively. Results The pressure treatment decreased the edema and ecchymosis significantly compared with the control group. The vibration treatment minimized edema, ecchymosis, sebaceous activity of the nose skin, pain score, and the need for anti-inflammatory medication, and increased the cast comfort significantly compared with the other groups (P < 0.0001). Conclusions Rapid regression of edema and ecchymosis may be achieved using the vibrating nasal cast technique that may minimize patient discomfort, pain, and sebaceous activity following rhinoplasty. Level of Evidence: 1

Surgery for Cerebral Palsy: Part 1. Classification and Operative Procedures for Pronation Deformity

1992 ◽  
Vol 17 (4) ◽  
pp. 391-395 ◽  
Author(s):  
C. GSCHWIND ◽  
M. TONKIN
Keyword(s):  
Cerebral Palsy ◽  
Full Range ◽  
Neutral Position ◽  
Pronator Quadratus ◽  
Pronator Teres ◽  
Group 4 ◽  
Active Transfer ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

32 patients with cerebral palsy underwent operations for pronation deformity. The deformity is classified into four groups. Patients in group 1 are capable of supination beyond neutral. No surgery is necessary. Those in group 2 are able to supinate to the neutral position. A pronator quadratus release is advised and may be combined with a flexor aponeurotic release. In group 3, patients have no active supination. However a full range of passive supination is readily achieved. A pronator teres transfer is advised. Patients in group 4 have no active supination. Full passive supination may be present, but is tight. A flexor aponeurotic release and a pronator quadratus release may unmask active supinator activity. An active transfer for supination is possible as a secondary procedure.

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