Impact of video review on surgical procedure determination for patients with cerebral palsy.
OBJECTIVE
Evaluation of patients with cerebral palsy is complex and variable. Several examinations, including video analysis, are necessary as part of the surgical planning process. Videotaped evaluation of the upper extremity in children with cerebral palsy has been used as an objective assessment of functional ability and deformity. The effect of review of these videotaped evaluations on altering the initially proposed surgical plan has not been evaluated.


METHODS
This is a retrospective study completed through a chart review. Inclusion criteria were all patients with cerebral palsy having upper extremity surgical consultation with the primary investigator (M.G.C.) between 1995 and 2005, having at least 2 presurgical consultations, completing a videotaped evaluation, and proceeding to surgery. Of 167 new patients, 94 patients, having 430 procedures, were eligible for the study. Five distinct anatomical areas (elbow, forearm, wrist, digit, and thumb) were delineated.


RESULTS
Changes to the initial surgical plan based on a review of the videotaped evaluation were made for 77 patients (138 procedures) and carried through to surgery for 68 patients (108 procedures). Those procedure changes that carried through to surgery most often involved the thumb, wrist, and digit, as compared to the elbow and forearm.


CONCLUSIONS
Videotaping evaluations allows for more precise understanding of ability and improves diagnosis. Changes to the initial presurgical plan were made in 77 patients (72%) after videotaped evaluation, most commonly for procedures addressing the wrist, digit, and thumb.
Carlson
Michelle G
MG
The Hospital for Special Surgery, New York, NY 10021, USA. carlsonm@hss.edu
Spincola
Laura J
LJ
Lewin
Jennifer
J
McDermott
Erin
E
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004551:Elbow Joint; D005260:Female; D050823:Hand Joints; D006801:Humans; D007223:Infant; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D018579:Patient Selection; D010808:Physical Examination; D012189:Retrospective Studies; D014743:Videotape Recording; D055815:Young Adult