engleski

Orthopaedic management of the hand spasm in patients with cerebral palsy

INTRODUCTION: The cerebral palsy encompasses a group of non-progressive, non-contagious neurological disorders that cause physical disability. Medical intervention is limited to the treatment and prevention of possible complications from cerebral palsy's consequences. AIM: To investigate the effectiveness of surgical treatment of the hand in patients with cerebral palsy. PATIENTS AND METHODES: A retrospective study was performed on 58 patients (37 male and 21 female) who underwent in total 100 hand surgical procedures treatment during 20 years (1985-2005). Indications for the operations were contracture and deformation of the radiocarpal joint, metacarpo-phalangeal joints and interphalangeal joints. RESULTS: Releases of contracture and tendon transfer were the most common types of procedures: proximal desinsertion and distalisation of the hand flexors transfer (37 cases), and transposition of the ulnar and the radial flexors to extensor side (11 cases). Operation sec. Matev for the thumb mobilization was performed in 24 cases. In two patients we performed derotational osteotomy of the radius and ulna. Arthrodesis of the radiocarpal joint was performed in 21 patients, and intermetacarpal thumb arthrodesis in 7 patients. Individual results of the treatment are discussed in the work, according to improved ability of holding objects, writing, reduced muscle spasms, alleviated pain and enhanced esthetic appearance. CONCLUSION: The best results are achieved in soft tissue operations accompanied with radiocarpal arthrodesis, followed by vigorous physical therapy. AO-plate is not suitable for the radiocarpal arthrodesis. “ Zuggurtung” and K-wires are suitable only for mild cases. Decreased sensibility and negative plaster immobilization test are not contraindication for the radiocarpal arthrodesis. Intensive treatment focused on hand function should be planned in children with more severe hand impairment in order to enhance voluntary movement and function.

Orthopaedic management; hand spasm; cerebral palsy

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