[The upper extremity in cerebral palsy. OP indications and surgical techniques]

In cerebral palsy patients, surgical treatment procedures of the upper extremity have an important place in the concept of multidisciplinary care. Nevertheless, operative indications remain selective and the number of operative interventions is limited in comparison to the lower extremity. For an appropriate surgical outcome, soft tissue techniques, applied in a multilevel strategy with clear consideration of functional aspects, are often sufficient. Osseous operative corrections, i.e. osteotomies or joint fusions, are restricted to selected cases. The retrospective evaluation of 209 patients who underwent surgical treatment of the upper extremity between 1975 and 2000 revealed a general satisfaction with the functional outcome in 68.4% of cases and cosmetic improvement in 97.6% of cases. The surgical treatment of upper limb deformities in cerebral palsy requires a particular focus on the correct indication and selection of an adequate surgical technique requiring outstanding experience.