Peculiar features of orthopaedic and somatic condition in patients with severe types of cerebral palsy

Abstract

Introduction Hip dislocation, accompanied by pain and segment malposition that affects the sitting posture and excludes passive verticalization,has been recognized as the main cause that worsens the quality of life in patients with severe types of cerebral palsy (GMFCS levels IV and V) with unreconstructable hip dislocation. The purpose of this study was to assess the orthopedic status of patients with spastic types of cerebral palsy that correspond to GMFCS functional levels IV and V with dislocated unreconstructable hip, as well as to examine their somatic status at admission for operative orthopedic treatment. Material and methods A continuous series of patients (41 patients, mean age 14.1 ± 2.3 years) with severe types of cerebral palsy that were admitted for palliative surgical treatment of femur dislocation and associated contractures and deformities in lower limb segments was studied. Orthopedic and somatic status was examined; radiological studies of the hip, knee joints, and feet were conducted. Results Changes in the femoral and acetabular components of the hip joints, detected with X-rays and CT, showed a nonreconstructable hip and confirmed the indications for palliative interventions. Clinically significant contractures and deformities in the knee joints and feet that required surgical treatment were present in 61 and 70.7 % of cases, respectively to levels. In this series of patients, concomitant diseases were found in all cases. Deficits of body mass index were present in 41.7 % of cases with GMFCS level IV and in 76.5 % of cases with GMFCS level V. Conclusion Severe pain and lower limb malposition is the leading symptomatic complex in patients with severe types of cerebral palsy of GMFCS levels IV and V that need correction. X-ray and CT findings in our series testified unreconstractable hip joint. In most cases, there were clinically significant deformations and contractures of the knee, ankle and foot that required a simultaneous correction. Thus, surgical interventions in such situations should be performed at several anatomic levels according to the principles of one-stage multilevel intervention. All patients in the study group had concomitant diseases and bone mass index deficits were observed. The situation with regard to concomitant diseases and body weight deficiency is more unfavorable in patients with GMFCS level V.

Keywords

• Keywords: cerebral palsy
• unnreconstructable hip dislocation
• severe motor disorders
• one-stage multilevel orthopedic surgery