title: Orthopedic surgery and mobility goals for children with cerebral palsy GMFCS level IV: what are we setting out to achieve?
abstract: BACKGROUND
  Multilevel orthopedic surgery is considered to be the gold standard treatment for ambulatory children with cerebral palsy (CP), classified at levels I, II, or III according to the Gross Motor Function Classification System (GMFCS). Hip enlocation and stability are the main goals of orthopedic intervention in the GMFCS level IV subgroup and are well researched; however, there is no evidence to date to support or challenge the effectiveness of orthopedic treatment to preserve functional mobility in this patient group. The aim of this study was to evaluate the results of orthopedic surgery to maintain or restore standing transfers and supported walking in children with CP at GMFCS level IV.
  
  
  METHODS
  Twenty-two children with CP GMFCS level IV who underwent orthopedic surgery to improve mobility between the years 2004 and 2008 were included in this study. A retrospective chart review was performed and a satisfaction questionnaire sent to all patients. The primary outcome measure was the attainment and maintenance of mobility goals 2 years post-surgery. The secondary outcome measures were family/patient satisfaction, Functional Mobility Scale (FMS), and complications.
  
  
  RESULTS
  The two goals identified by the patients and carers were standing transfers and supported walking. At the 2-year post-surgery assessment, 14 children (63.6 %) did not reach their pre-determined goals. In the questionnaire, 21.4 % of the families reported that surgery was not beneficial. The FMS score remained unchanged in 95.4 % of the patients. Fourteen patients (63.6 %) had at least one complication that prolonged their post-operative rehabilitation (e.g., neuropraxia).
  
  
  CONCLUSIONS
  This study suggests that orthopedic surgery in children with CP at GMFCS level IV is unlikely to maintain or restore mobility. Furthermore, it carries a significant risk of complications.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Orthopaedic Department, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia.
authors.forename: Francesco Camara
authors.initials: FC
authors.lastname: Blumetti
authors.forename: Jenny Chia Ning
authors.initials: JC
authors.lastname: Wu
authors.forename: Karen Vanessa
authors.initials: KV
authors.lastname: Bau
authors.forename: Brian
authors.initials: B
authors.lastname: Martin
authors.forename: Sally Anne
authors.initials: SA
authors.lastname: Hobson
authors.forename: Matthias Wolfgang
authors.initials: MW
authors.lastname: Axt
authors.forename: Paulo
authors.initials: P
authors.lastname: Selber
keywords: Cerebral palsy; Mobility; Orthopedic surgery