Surgery for cerebral palsy: Part 1. Classification and operative procedures for pronation deformity

Area of Science:

• Orthopedic Surgery
• Pediatric Rehabilitation
• Neuromuscular Disorders

Background:

• Cerebral palsy (CP) frequently causes upper extremity deformities, notably pronation.
• Pronation deformity in CP impacts hand function and daily activities.
• Effective surgical management requires precise classification of the deformity's severity.

Purpose of the Study:

• To present a classification system for pronation deformities in cerebral palsy.
• To correlate deformity severity with appropriate surgical interventions.
• To evaluate treatment outcomes based on the proposed classification.

Main Methods:

• A cohort of 32 patients with cerebral palsy and pronation deformity was analyzed.
• Patients were categorized into four groups based on active and passive supination capabilities.
• Surgical procedures were tailored to each group, including pronator quadratus release, flexor aponeurotic release, and pronator teres transfer.

Main Results:

• Group 1 (supination beyond neutral) required no surgery.
• Group 2 (neutral supination) benefited from pronator quadratus release, potentially with flexor aponeurotic release.
• Group 3 (no active, full passive supination) was treated with pronator teres transfer.
• Group 4 (no active, tight passive supination) underwent releases to unmask activity, with transfers as a secondary option.

Conclusions:

• A four-group classification system effectively guides surgical treatment for pronation deformities in cerebral palsy.
• Tailored surgical approaches based on supination capacity optimize functional outcomes.
• The classification aids in selecting appropriate procedures, from conservative management to complex transfers.