Wrist fusion in patients with severe quadriplegic cerebral palsy.
We report clinical and radiographic outcomes of wrist fusion achieved with pin or plate fixation in 14 patients with severe quadriplegic cerebral palsy (CP) (19 wrists). Average patient age at the time of surgery was 16.8 ± 1.7 years (14-20 years). Mean follow-up time for the 14 patients was 5.9 ± 3.1 years (range, 1-11 years). Indication for surgery was severe wrist deformity that interfered with hygienic care. Few complications occurred, and outcomes were satisfactory. Statistically significant mean difference was shown between the pre- and postoperative radiographic angles (37°, P = 0.001, and 24°, P = 0.04, for lateral and anteroposterior views, respectively). Caregivers reported that appearance was the most perceived rationale for surgery (63 %). Improved hygienic care was the primary perceived benefit. The majority (88 %) were satisfied with the results. We recommend wrist fusion to improve hygienic care, positioning, and appearance of the wrist, hand, and fingers in patients with severe quadriplegic CP.
Department of Orthopedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, 1600 Rockland Road, Wilmington, DE 19803, USA. ahmed_thabetortho@yahoo.com
Ahmed M
AM
Thabet
Durga Nagaraju
DN
Kowtharapu
Freeman
F
Miller
Kirk W
KW
Dabney
Suken A
SA
Shah
Kenneth
K
Rogers
Laurens
L
Holmes
D000203:Activities of Daily Living; D000293:Adolescent; D001174:Arthrodesis / Q000379:methods*; D001176:Arthrogryposis / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D001858:Bone Nails; D001860:Bone Plates; D002547:Cerebral Palsy / Q000150:complications* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D008297:Male; D011782:Quadriplegia / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013536:Suture Techniques; D052256:Tendinopathy / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult