gms | German Medical Science

Objectives/Interrogation: Cerebral palsy is characterised by static brain injury with progressive musculoskeletal manifestations. This includes spasticity with wrist deformity in a hyperflexed and ulna deviated position. Treatment of severe deformity requires bony correction to restore neutral position, which is usually achieved by a wrist fusion. Our aim was to assess patient and carers post-operative satisfaction following wrist arthrodesis to determine what benefits were being gained from this procedure.

Methods: This is a retrospective case series assessing patients with cerebral palsy who underwent wrist arthrodesis at our institution by a single surgeon with a minimum of 1-year follow-up. We developed a visual analogue scale questionnaire of eight questions in which patients and carers rated the satisfaction of their wrist fusion with regards to pain, function, hygiene, appearance, daily care and overall satisfaction. For each question, a scale from -10 to +10 was given: +10 being the best outcome, 0 being no change, and -10 being the worst outcome. Surveys were anonymous and sent to patients via post. Results of the surveys were our our primary outcomes. Secondary outcomes were complications documented in patient records and radiographic outcome measures from routine post-operative follow-up.

Results and Conclusions: We identified 13 patients who underwent wrist arthrodesis. Four patients had bilateral procedures, giving a total of 17 wrists. Of these 13 patients, eight were quadriplegic and five hemiplegic. Age at arthrodesis ranged from 15-22 years. Pre-operative joint contracture ranged from 60-90 degrees. There were two deaths not related to the procedure. A total of 11 surveys were sent and eight returned (73% response rate).

Results from the survey showed the greatest improvements were made in appearance with a mean rating of +6.6, ease of daily cares (+4.9), hygiene (+3.2), and hand function (+2.7). There was a slightly negative change in pain levels (-0.7). Overall, there was a positive satisfaction rating (+5.0).

Complications from the procedure included one non-union, one superficial wound breakdown, one removal of metalware for prominence and one pain syndrome.

Wrist fusion appears to be a beneficial procedure for cerebral palsy patients with severe wrist deformity. Greatest improvements are in daily cares, hygiene and cosmetic appearance. However, it does not significantly improve patient function or pain levels. Patients and carers should be counselled about the limitations of this operation.