Surgical approach to forearm pronation deformity in patients with cerebral palsy: a systematic review
Insights
Surgical interventions for pronation deformity in cerebral palsy (CP) patients show improved supination, but functional gains are unclear. The low quality of evidence prevents determining the best surgical technique for CP patients.
Area of Science:
- Orthopedic surgery
- Pediatric rehabilitation
- Cerebral palsy research
Background:
- Pronation deformity significantly impairs upper limb function in cerebral palsy (CP) patients.
- Current literature lacks consensus on optimal surgical techniques for correcting CP-related pronation deformities.
- This study aims to synthesize outcomes of various surgical interventions for pronation deformity in CP.
Approach:
- A systematic literature search of MEDLINE and Embase was conducted up to December 2021.
- Included studies focused on surgical interventions for pronation deformity in CP patients with reported outcomes.
- Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool.
Key Points:
- Nineteen studies involving 475 patients and eight surgical techniques were analyzed.
- Most studies reported improvements in active supination post-surgery.
- Functional outcome gains were inconsistently reported, with significant heterogeneity and 46 complications noted.
Conclusions:
- While surgery may improve supination and some function in CP patients with pronation deformity, the evidence quality is poor.
- High risk of bias due to low study validity precludes definitive conclusions on preferred surgical techniques.
- Further high-quality research is needed to guide surgical decision-making for pronation deformities in cerebral palsy.
Background:
Pronation deformity in patients with cerebral palsy can have a major impact on upper limb functionality. There is lack of consensus in the literature about the preferred surgical technique to address this deformity.
Study Aim:
To evaluate and synthesize the outcome of different surgical techniques for pronation deformity in patients with cerebral palsy.
Methodology:
The databases MEDLINE and Embase were searched for publications up to December 2021. Articles were considered eligible for inclusion when the included patients had a pronation deformity caused by cerebral palsy and results of surgical intervention for pronation deformity were examined. Evaluation of the quality of the retrieved study was conducted using the MINORS tool. Meta-analysis was not possible due to the heterogeneity of interventions and reported outcomes.
Results:
Nineteen studies, involving 475 patients and eight different techniques were included. All studies reported gain of active supination in most patients. The effect of surgery on functional gain was less clear and there was a large heterogeneity of reported functional outcome measures. There were 46 reported complications. Overall quality of study design was poor, illustrated by the average MINOR score of 6.9/16. Overall, there is a high risk of bias due to poor internal and external validity of the studies.
Conclusion:
Despite positive reports on gain in supination and functionality after most procedures addressing pronation deformity in CP patients, no conclusions can be drawn concerning the preferred technique due to the low quality of the evidence.
