[Muscular lengthening of the triceps by successive casts in children with cerebral palsy]
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J Cottalorda1, V Gautheron, E Charmet
1Service de Chirurgie Infantile, Hôpital Nord, Saint-Etienne.
Insights
Serial plaster-cast elongation of the triceps surae muscle in children with cerebral palsy offers a safe and effective alternative to surgery. This technique provides comparable results with minimal complications for improving foot dorsiflexion.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Neuromuscular Disorders
Context:
- Cerebral palsy (CP) frequently involves equinus foot deformity due to triceps surae spasticity.
- Conservative and surgical interventions aim to improve ankle range of motion and ambulatory function.
- Serial plaster-cast elongation presents a non-surgical approach to address triceps surae contractures.
Purpose:
- To evaluate the efficacy and safety of serial plaster-cast elongation of the triceps surae in ambulatory children with cerebral palsy.
- To compare the outcomes of this technique with surgical lengthening and botulinum-A toxin injections.
- To assess the improvement in passive foot dorsiflexion and identify any complications.
Summary:
- A retrospective review of 28 triceps surae elongations in 20 children with cerebral palsy (hemiplegic, diplegic, quadriparetic) was conducted.
- The technique involves serial plaster casts to gradually lengthen the triceps surae muscle.
- Post-elongation, significant improvements in passive foot dorsiflexion were observed, with one case of persistent varus foot deformity.
Impact:
- Serial plaster-cast elongation is a quick, safe, and simple technique for managing triceps surae contractures in children with CP.
- It offers results comparable to surgical lengthening and botulinum-A toxin, serving as a valuable alternative.
- While recurrence of equinus is possible, this method preserves the option for future surgical intervention if needed.
Purpose Of The Study:
Twenty children with cerebral palsy who underwent elongation of the triceps surae using successive plaster-casts (28 short triceps) were reviewed. This study was retrospective.
Material And Methods:
Among the eighteen children, 10 were hemiplegic, 8 were diplegic and 2 were spastic quadriparetic. All of them except one were ambulatory children. The authors describe their elongation technique by plaster-casts and the treatment they lead. The mean age at time of elongation was 4 years and 6 months (range 2 years 4 months to 8 years). The passive dorsiflexion of the foot before elongation was of 0 degree (range -20 degrees to +10 degrees) knee in extension, and of 5 degrees (range -15 degrees to +15 degrees) knee in flexion.
Results:
The passive dorsiflexion of the foot after elongation was of 23 degrees (range +10 degrees to +30 degrees) knee in extension, and of 27 degrees (range +10 degrees to +35 degrees) knee in flexion. One major complication was noted: the persistence of a varus foot in child after elongation. 24 elongations were reviewed with a mean follow-up of 21 months (range 12 months to 30 months). The passive dorsiflexion of the foot was of 10 degrees (range 0 degree to +20 degrees) knee in extension and of 17 degrees (range -5 degrees to +25 degrees) knee in flexion.
Discussion:
Compared to different procedures (surgical lengthening, botulinum-A toxin) elongation by successive plaster-casts is a quick, safe, complication-free, and simple technique, whose results are equivalent. Even if recurrence of equinus is probable, a surgical procedure of lengthening could be made on an operative-free tendon.
Conclusion:
Elongation of the triceps surae muscle by successive plaster-casts constitutes a safe alternative technique compared to surgical procedure.