Orthopaedic complications of hemiparetic forms of cerebral palsy: problems of the lower extremities (literature review)

Abstract

Introduction Spastic hemiplegia (a unilateral neurological disorder) is encountered more often in full-term infants. In most cases, the cause of the condition is intrauterine or perinatal stroke. Children with hemiparetic forms maintain cognitive and functional capabilities in combination with the ability to move independently. Among other forms of cerebral palsy, hemiparetic spastic forms range from 10.4 to 15.3 %. Types with mild motor impairments predominate according to the Gross Motor Function Classification System: 87.8 % are level I GMFCS, 7.1 % are level II GMFCS. The purpose of the work was to summarize information on the use of orthopaedic interventions for hemiparetic forms of cerebral palsy, both from the point of view of their planning and completeness of correction of anatomical disorders including lower limb length discrepancy, and assessment of functional results based on gait analysis. Materials and methods The search for publications was carried out in open electronic sources of medical literature PubMed, eLIBRARY, Scopus, Elsevier, Springer, Research Gate with a search depth of 20 years (2002–2022). The following inclusion criteria were used: systematic reviews of the literature, review articles, cohort studies on the topic of multilevel interventions for hemiparetic types of cerebral palsy. Results and discussion Lower limb length discrepancy of 1 cm or more affects the kinematics of the affected and intact contralateral limb. The unaffected limb is characterized by a compensatory flexion in the hip and knee joints and excessive dorsal flexion in the stance phase. On the affected side, the contribution of shortening to the development of pathological kinematics of the pelvis and spine is especially important. There is a high probability of equinus contracture after surgical correction due to unresolved discrepancy in the length of the lower extremities. Methods for correcting length discrepancy are conservative (compensation with shoes), and surgical lengthening of the lower leg, epiphyseodesis of the contralateral limb, shortening of the contralateral limb. There is no opinion in the literature about the preference of this or that method, and on the necessary magnitude of limb length correction. Conclusion The assessment of limb length discrepancy and contribution of this orthopaedic component to systemic movement disorders in spastic hemiparesis is based on computed tomography or magnetic resonance imaging, as well as on computer gait analysis. In the literature, the issue of limb length correction is considered separately from the complex of other orthopaedic interventions, while the features of correction with regard to spontaneous growth potential or after growth completion have not been defined. The advantage of equalizing the limb length in children with temporary epiphyseodesis over distraction osteogenesis is only supposed. There is not enough data on the effect of the limb length correction magnitude in patients with spastic hemiplegia on the parameters of computer gait analysis.

Keywords

• unilateral cerebral palsy
• orthopedic surgery
• lower limb length discrepancy