Wrist arthrodesis in children with cerebral palsy

Wrist arthrodesis was performed on 19 upper extremities in 18 children with cerebral palsy to correct volar flexion and ulnar deviation deformities. Mean age at the time of surgery was 15.8 years, and mean follow-up was 4.7 years. Review of medical records and radiographs and follow-up clinical examination, including standardized functional testing and a child/parent questionnaire, were performed to assess outcome in technical, functional, and satisfaction domains. Technical domain outcomes were best when arthrodesis was performed by proximal row carpectomy with plate fixation. Functional improvement, as documented by the House scale, averaged 1.8 levels, with 14 children (83.3%) showing improvement. Child/parent satisfaction with cosmetic, hygienic, and functional outcomes was high, ranging from 72 to 94%. Wrist arthrodesis, when combined with appropriate procedures for the forearm, fingers, and thumb, provided excellent technical, functional, and satisfaction domain outcomes for children with cerebral palsy, particularly those with more severe upper extremity involvement, dyskinetic type cerebral palsy, or poor motivation for rehabilitation.