Surgical Reconstruction of Thumb-in-Palm Deformity in Spastic Cerebral Palsy Children

Abstract

Cerebral palsy is the musculoskeletal manifestation of a non progressive central nervous system lesion that usually occurs due to a perinatal insult to the brain. Though the cerebral insult is static the musculoskeletal pathology is progressive. Spasticity leads to shortening of musculoskeletal units, which in turn causes fixed contractures and eventually leads to torsional abnormalities of long bones, joint instability, deformities, and degenerative arthritis. The clinical manifestations may vary widely, ranging from an intelligent child with mild spasticity of the hand to a completely wheelchair bound child who is unable to communicate with his environment. All patients with cerebral palsy have the following common features. •Cerebral palsy is the result of a brain lesion. Therefore, the spinal cord and muscles are structurally and biochemically normal. •The brain lesion must be fixed and non progressive. Thus, all of the progressive neurodegenerative disorders are excluded from the definition. •The abnormality of the brain results in motor impairment. The surgical procedures as such are not very technically demanding but the assessment, decision-making, and selecting a procedure for the given patient make this field challenging. When done well, the results are rewarding not only in terms of improvement in hand function but also in appearance and personal hygiene, which leads to better self-image and permits better acceptance in the society. The goals of surgical intervention were set depending on the preoperative functional status. When the child has a good voluntary motor control the goals are to improve function and appearance. In cases of severe involvement, surgery is a reasonable option if it facilitates the nursing care by the parents or the care giver. The purpose of this study, was to evaluate the short term results of surgical reconstruction of thumb-in-palm deformity in cerebral palsy children. This is a prospective case series study that included thirty cerebral palsy children with thumb-in-palm deformity treated with surgical reconstruction of thumb. Our study that was conducted in national institute of neuromotor system Cairo-Egypt between January 2014 and December 2015 on 30 patients with spastic CP. The mean duration of follow up was 10 months (range 6-20 months). Nineteen patients were males and eleven patients were females. All patients were enrolled in this study on basis of precise inclusion and exclusion criteria. The mean age of patients included in our study at the time of surgery was 7 years (range from 4-12 years). Twenty three patients (76.67%) were hemiplegic and seven patients (23.33%) were diplegic. Different surgical procedures were done according to the patients' needs. All our patients had thumb web z-plasty /fascial release, adductor release in palm, first dorsal interosseous release, extensor pollicis longus rerouting done, 100% of static house classification type 2 of our patients had release of contracted web space done, 100% of static house classification type 3 of our patients had the MCP joint capsulodesis done, 100% of static house classification type 4 of our patients had both release of contracted web space and FPL lengthening done.