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Similar to cerebral palsy and its appropriate surgical mx.pptx
cerebral palsy and its appropriate surgical mx.pptx
- 1. Surgical management in CerebralPalsy Moderator – Prof. P.G . Menon Presenter Dr. Kaustav Mukherjee
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- 7. Problems with tendontransfer
- 8. Bony surgery • Correctthe lever arm dysfunction • Correct deformities of spine and extremity that disturbs sitting, standing, and walking • Reduce and stabilise dislocated hip • Fuses unstable joints
- 9. DECISION MAKING • history •Clinical evaluation • GMFCS • Investigations • Gait analysis • Repeated assessment preoperatively is important !!
- 11. Surgical procedures –Hip & knee
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- 13. Spectrum of HIPproblems
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- 16. “Hip at risk”signs
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- 18. Why hip subluxationneeds to be managed ?
- 19. Surgical options – •PREVENTIVE- Soft tissue release- Adductor longus, gracilis, Adductor brevis and iliopsoas- all 4 has to be released . • RECONSTRUCTIVE- Femoral procedures, pelvic procedures • SALVAGE
- 20. Indications for softtissue release • Child younger than 8 yrs • MP > 30 • Hip flexion contracture >20 degrees • Hip abduction <30 degrees Psoas tenotomy in non ambulants done at Lesser trochanter, whereas in ambulatory child release is done at pelvic brim ( so no significant loss of flexor power) Adductors are in close proximity with obturator nerve which lies on adductor brevis • Obturator neurectomy can be done in non ambulants • C/I in athetoid CP
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- 22. Management of hipdislocation
- 24. Problems in theKNEE
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- 26. Semitendinosus transfer • STis a knee flexor and hip extensor • Transferring ST removes it as a knee flexor but retains the hip extensor function • Hip e tensor function is important as it prevents the increse in anterior tilt of pelvis
- 27. Dealing with FFDof the knee • FFD causes Quadriceps fatigue, anterior knee pain , patella stress fracture and worsening crouch • Mild FFD can be treated by casting / hamstring lengthening • Distal femoral extension osteotomy is advocated in older children • Guided growth of anterior femur is also an option
- 28. • FFD <15degrees- managed by casting / hamstring release • FFD- 15- 25 degrees- medial hamstring release/ lengthening + ST transfer to adductor magnus • FFD>25 degrees- requires bony procedures- anterior femur guided growth/ distal femur extension osteotomy
- 29. Hamstring release • Doneif popliteal angle is >45 degrees • Proximal / distal hamstring release • ST tenotomy done in non ambulants • ST transfer done in ambulants • SM/ gracilis myofascial release
- 30. Stiff knee gait •Knee extension throughout the gait cycle is <30 degrees • Stiff knee gait characterized by decreased knee flexion during swing phase leafing to poor foot clearance • Reduced gait velocity , step length often accompanied by tripping and falling. • Primary cause is spasticity / contracture of rectus femoris • Rx- rectus transfer medially to ST / laterally to ITB
- 31. ANKLE & FOOTdeformity corrections Equinus correction
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