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Functional outcome of upper limb tendon transfers performed in children with spastic hemiplegia
J H Roth1, S E O'Grady, R S Richards
1Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.
Insights
Reconstructive surgery, including tendon transfers and fusions, significantly improved upper limb function in children with spastic hemiplegia. This surgical intervention enhanced active assistance and wrist motion, leading to high parental satisfaction.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Neuromuscular Disorders
Background:
- Spastic hemiplegia commonly causes upper limb muscle imbalance in children.
- Functional limitations significantly impact daily activities and quality of life.
Purpose of the Study:
- To evaluate the effectiveness of reconstructive surgery in improving functional abilities of children with spastic hemiplegia.
- To assess changes in upper limb function and patient satisfaction post-surgery.
Main Methods:
- A cohort of 17 children under 16 with spastic hemiplegia underwent reconstructive surgery.
- Procedures included tendon transfers, tendon lengthenings, and thumb metacarpophalangeal fusion.
- Functional assessment used House's scale pre-operatively and at a mean 2.6-year follow-up.
Main Results:
- Surgery improved functional grading by two grades, from good passive assist to fair active assist.
- Significant improvements were observed in wrist motion arc and forearm rotation.
- High levels of parental satisfaction were reported post-intervention.
Conclusions:
- Reconstructive surgery is an effective treatment for improving upper limb functional ability in pediatric spastic hemiplegia.
- The surgical approach enhances active assistance and range of motion, positively impacting patient outcomes.
Abstract:
Children with spastic hemiplegia often present with upper limb muscle imbalance. The purpose of this paper was to determine whether reconstructive surgery improved their functional ability. 17 children under the age of 16 years with spastic hemiplegia underwent reconstruction that included tendon transfers, tendon lengthenings and thumb metacarpophalangeal fusion. They were assessed pre-operatively and at an average follow-up period of 2.6 years. Children's abilities were classified according to House's functional rating scale. Tendon transfers improved functional grading by two grades, from good passive assist to fair active assist. Improvement in the arc of wrist motion and forearm rotation was also seen. Parental satisfaction was high. Reconstructive surgery improved the functional abilities in this group of children with spastic hemiplegia.