gms | German Medical Science

Objectives/Interrogation: Management of patients with cerebral palsy (CP) with upper extremity involvement is complex. One known deformity in this population is the development of contracture about the wrist.

The role of wrist arthrodesis for patients with CP has become much more common. This option was previously used only when the patient has little or no function in fear that wrist arthrodesis will have a negative effect on grip strength by means of altering the tenodesis effect of the finger tendons. To our knowledge, treatment of this complex issue has not been reported among patients in the military health care system.

The goal of this study was to examine the outcomes and clinical course of wrist arthrodesis in this population.

Methods: Study design was a prospective case series. Computer-based review of operative codes and a subsequent chart review identified 5 children who had wrist arthrodesis performed between 2014-2018. All patients were diagnosed with cerebral palsy of various severity. 2 patients had hemiplegia, the other 3 patients had spastic quadriplegia. All patients had moderate to severe cognitive impairment and were dependent on their parents and caregivers. Age range at the time of surgery was 13-35 years of age. Mean follow-up was 3 years (range, 0.5-4.3 years). All children are enrolled within the military medical insurance program, TRICARE. Their surgical procedure and post-operative care were all within the military health system.

Results and Conclusions: Prior to surgery, 4 patients were given a trial of casting. This was meant to simulate neutral wrist position obtained by wrist fusion. The parents and the patients observed improved function with casting and subsequently underwent wrist arthrodesis.

In 4 cases, wrist arthrodesis was performed with a proximal row carpectomy. In those cases, the removed carpal bones were used as autograft to aide in fusion. Plate fixation with the Acumed wrist fusion plate or with a Synthes small fragment LCP 3.5 mm plate.

Post-operatively, all patients were casted for 6-12 weeks and enrolled in formal occupational therapy.

All patients had improved function and cosmesis after the procedure by patient and parent report. This was true for patients with low and high GMFCS classification. None of these patients required further surgery after the index procedure.

With careful patient selection, surgical intervention for the upper extremity in patients with wrist contracture related to CP may be indicated to improve function, cosmesis, and hygiene.