The Baumann procedure to correct equinus gait in children with diplegic cerebral palsy: long-term results
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Published on: August 9, 2024
M Svehlík1, T Kraus, G Steinwender
1Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
Insights
The Baumann procedure effectively treats equinus gait in children with spastic cerebral palsy (CP). This ten-year study shows sustained improvements in ankle function and power, making it a recommended surgical option.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Equinus gait is a common challenge in spastic cerebral palsy (CP).
- Current treatment recommendations lack consistency and robust evidence.
- The long-term outcomes of the Baumann procedure for CP are not well-established.
Purpose of the Study:
- To evaluate the long-term effectiveness of the Baumann procedure in children with diplegic CP.
- To assess changes in ankle joint kinematics and kinetics after the procedure.
- To determine the rates of overcorrection and recurrent equinus.
Main Methods:
- A ten-year follow-up study of 18 children (21 limbs) with diplegic CP.
- Utilized three-dimensional instrumented gait analysis.
- Monitored kinematic and kinetic parameters of the ankle joint.
Main Results:
- Significant and sustained improvements in ankle joint kinematic parameters were observed.
- Normalization of key kinematic and kinetic timing parameters occurred.
- Increased maximum ankle power generation and low rates of complications were noted.
Conclusions:
- The Baumann procedure demonstrates significant long-term benefits for equinus gait in spastic CP.
- It offers selective correction without impairing muscle architecture.
- Recommended as a preferred surgical method for mild, fixed equinus deformities in CP.
Abstract:
Although equinus gait is the most common abnormality in children with spastic cerebral palsy (CP) there is no consistency in recommendations for treatment, and evidence for best practice is lacking. The Baumann procedure allows selective fractional lengthening of the gastrocnemii and soleus muscles but the long-term outcome is not known. We followed a group of 18 children (21 limbs) with diplegic CP for ten years using three-dimensional instrumented gait analysis. The kinematic parameters of the ankle joint improved significantly following this procedure and were maintained until the end of follow-up. We observed a normalisation of the timing of the key kinematic and kinetic parameters, and an increase in the maximum generation of power of the ankle. There was a low rate of overcorrection (9.5%, n = 2), and a rate of recurrent equinus similar to that found with other techniques (23.8%, n = 5). As the procedure does not impair the muscle architecture, and allows for selective correction of the contracted gastrocnemii and soleus, it may be recommended as the preferred method for correction of a mild fixed equinus deformity.
