A new technique of flexor carpi ulnaris transfer in multilevel surgery for upper extremity deformities in spastic cerebral palsy.

Aim To assess treatment outcomes of cerebral palsy (CP) patients who underwent upper limb surgical treatment including new technique of flexor carpi ulnaris (FCU) transfer. Methods The study included an outcome of orthopaedic surgeries in 30 upper limbs of 25 CP patients aged 10 to 24 years (mean age of 15.1 years). In addition to standard orthopaedic assessment, we used the integral scales of the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS). Functional disorders of the upper limb were also evaluated with classifications of Van Heest, House, Gshwind and Tonkin. Results A total of 30 surgical interventions were performed. In seven patients with hemiparesis, surgical treatment was accompanied by simultaneous intervention on the lower limb. Improvement of the functional capabilities and cosmetic appearance was noted in all cases in a follow-up over 12 months, as evidenced by an improvement in the functional class according to Van Heest classification. Conclusion A new technique of FCU transfer to the radius showed to be an effective method to address pronation contracture of the forearm joints and can be used in combination with other elements of surgical intervention for elbow and thumb contractures. The FCU rerouting and transfer to distal radius is a good option in the absence of active supination. Distal release of FCU weakening flexion forces with a simultaneous procedure restoring active wrist extension provides satisfactory outcomes in the treatment of associated flexed wrist contracture.

Management of severe congenital flexion deformity of the knee using Ilizarov method.

The aim of this study was to examine the effectiveness of Ilizarov method in severe congenital flexion deformity of the knee. This was a retrospective study of eight consecutive bilateral cases (five girls and three boys, with mean age of 4 years, involving 16 knees) with minimum 2-year follow-up. Four patients had multiple congenital contractures and two patients each had popliteal pterygium syndrome and complete tibial hemimelia. All patients were treated with Ilizarov fixator and gradual correction (additional soft tissue releases in three knees). Six patients had bilateral foot and ankle deformity treated with the same fixator, and cases with tibial hemimelia had centralization of fibula and quadriceps reconstruction. Flexion deformity could be corrected in all cases. Mean duration of dynamic phase was 78.5 (55-108) days, that of static phase was 42.4 (7-100) days, and total duration of external fixation was 120.9 (87-186) days. At mean follow-up of 34.5 (23-60) months, flexion deformity improved from the preoperative value of 74.9° (50°-130°) to 13.7° (10°-16°), and passive arc of motion of knee improved from the preoperative value of 38.8° (20°-55°) to 83.6° (55°-110°). Both were statistically significant (P < 0.0001). All patients (previously nonambulatory) were ambulatory with brace and support. All patients faced pin-tract and skin complications that were successfully managed. Ilizarov method is effective in severe congenital flexion deformity of the knee in improving ambulatory status. Realignment of quadriceps mechanism and limb mechanical axis (including ankle and foot deformities) must be given due importance. Minor recurrences of deformity must be expected in all cases.