Understanding in Children with Cerebral Palsy: Orthopedic Problems

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Dmitry Popkov (Editor)
Ilizarov National Medical Research Center for Traumatology and Orthopedics, Russia

Series: Pediatrics – Laboratory and Clinical Research, Neurology – Laboratory and Clinical Research Developments
BISAC: MED069000, MED056000

Cerebral palsy presents stable encephalopathy that systemically influences on the child’s and adult’s organism. Orthopedic complications of cerebral palsy possess on the contrary progressive features and those complications cause gradual failure of motor ability of a person: impaired walking, loss of postural ability, reduced self-care and inclusion, finally quality of life becoming much worse. That is why orthopedic aspects are of great importance in children with cerebral palsy.

This volume presents a collection of chapters covering a wide range of problems, from a system of universal classification of dysfunctions in Cerebral Palsy and practical issues of prevention of orthopedic complications orthopedic to surgery (diagnostics and quantitative interpretation of gait disorders in such patients, optimal methods of surgical intervention, hip surgery, spinal surgery) and aspects of nutritive status of this specific category of patients, associated comorbidities and their influence and connection with orthopedic problems. Furthermore, three chapters are dedicated to the anesthetic aspects of orthopedic surgery. The substantiation is given to the methods of combined anesthesia and sedation during surgery, as well as in the immediate postoperative period, taking into account concomitant epilepsy, increased intracranial pressure and spasticity in such children.

Single-event multilevel orthopedic surgery is a recognized gold standard in ambulatory patients, though it varies according to gait patterns and associated orthopedic problems causing motor disorders. The book contains explanations and methodology of surgeries for conventional gait patterns, as well as in iatrogenic disorders caused by previous unreasonable interventions. The chapter on the correction of deformities and dysfunctions of the upper limb shows the first applied transfer of m.flexor cubitus ulnaris to the radius, which gave extremely positive results both in terms of function and aesthetics.

Unfortunately, in Russia the number of CP patients with iatrogenic orthopedic disorders is high. Extremely negative consequences in the form of weakness of the triceps muscles after percutaneous fibromyotomies (so-called “Ulzibat method”) or lengthening of the Achilles tendon in diplegia performed before the age of five years and before the development of muscle retraction lead to the development of crouch gait even in patients with high motor potential (GMFCS I, II). This complication of unreasonable surgical interventions develops in 5-7 years after primary surgery and in the opinion of doctors and parents is not related to previous procedures. This book, based on 3D-instrumented gait analysis, shows the features of iatrogenic crouch gait, as well as methods of surgical correction of this difficult situation.

The data presented in this book are based, on the one hand, on the personal practical and scientific experience of each author, and on the other hand, the entire team of authors works in collaboration with each other, coordinating their decisions and interventions with colleagues, thus ensuring continuity in treatment of children and adults suffering from cerebral palsy.
(Imprint: Nova Medicine and Health)

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Table of Contents

Foreword

Preface

Acknowledgements

Introduction

Chapter 1. Definition and Clinical Classification of Cerebral Palsy. Functional Classification Systems. Development of a Cerebral Palsy Follow-Up Registry in the Tyumen Region (CPUP-Tyumen Region)
(Vera Zmanovskaya, MD, PhD, Elena Levitina, MD, PhD, Svetlana Ushakova, MD, PhD, Grigory Volsky, MD, and Alena Vorobeva, MD, Children’s Psychoneurological Medical Rehabilitation Center “Nadezhda”, Tyumen, Russia, and others)

Chapter 2. How to Prevent Orthopedic Complications and Early Surgery in CP Children: Role of Botulinum Toxin Therapy
(Vera Zmanovskaya, MD, PhD, Elena Levitina, MD, PhD, Svetlana Ushakova, MD, PhD, Children’s Psychoneurological Medical Rehabilitation Center “Nadezhda”, Tyumen, Russia, and others)

Chapter 3. The Role of Orthotics in Preoperative and Postoperative Management of Children with Cerebral Palsy
(Grigory Volsky, MD, Children’s Psychoneurological Medical Rehabilitation Xenter “Nadezhda”, Tyumen, Russia)

Chapter 4. Nutritional Care in Children with Cerebral Palsy. Perioperative Management of Patients with Cerebral Palsy Undergoing Orthopedic Surgery
(Anna Shaitarova, MD, PhD, Olga Perfilova, MD, PhD, and Elena Khramova, MD, PhD, Tyumen State Medical University of the Ministry of Healthcare of the Russian Federation, Tyumen, Russia)

Chapter 5. Comorbid Disorders in Children with Cerebral Palsy
(Tatyana Ryabykh, MD, and Sergey Ryabykh MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 6. Anesthetic Management in Cerebral Palsy
(Vadim Evreinov, MD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 7. Single-Event Multilevel Orthopedic Surgery in Children with True Equinus Gait and Jump Knee Gait
(Sergey Leonchuk, MD, PhD, Georgy Chibirov, MD, PhD, Tamara Dolganova, MD, PhD, Dmitry Dolganov, PhD, and Dmitry Popkov, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 8. Correction of Flexible Planovalgus Foot Deformity in Children with Cerebral Palsy
(Sergey Leonchuk, MD, PhD, Eduard Mingazov, MD, PhD, Evgeny Gorbach, MD, Konstantin Diachkov, MD, PhD, and Alena Vorobeva, MD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia, and others)

Chapter 9. Distal Rectus Femoris Transfer as a Part of Single-Event Multilevel Orthopedic Surgery
(Georgy Chibirov, MD, PhD, Orhan Gatamov, MD, Tamara Dolganova, MD, PhD, Dmitry Dolganov, PhD, and Arnold Popkov, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 10. Single-Event Multilevel Orthopedic Surgery in CP Patients with Natural and Iatrogenic Crouch Gait
(Tamara Dolganova, MD, PhD, Georgy Chibirov, MD, PhD, Orhan Gatamov, MD, Dmitry Dolganov, PhD, and Dmitry Popkov, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 11. Reconstructive Hip Surgery as a Part of Multilevel Surgery in Non-Ambulant CP Children. Hip Development after Reconstructive Surgery
(Ahmed Tomov, MD, Georgy Chibirov, MD, PhD, Sinisa Ducic, MD, PhD, Arnold Popkov, MD, PhD, and Anna Aranovich, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia, and others)

Chapter 12. Palliative Hip Surgery in Non-Ambulant Adolescents and Adults with Cerebral Palsy
(Ramil Bidiamshin, MD, Arnold Popkov, MD, PhD, Anna Aranovich, MD, PhD, Vasily Tropin, MD, PhD, and Alexander Chertischev, MD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 13. Hip Arthroplasty in Ambulant Patient with Cerebral Palsy
(Sergey Khrypov, MD, PhD, Valeriy Umnov, MD, PhD, Alexander Veselov, MD, PhD, and Diana Krasavina, MD, PhD, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia, and others)

Chapter 14. Management of the Pain in Patients with Cerebral Palsy during Hip Surgery
(Vadim Evreinov, MD, and Tatiana Zhirova, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia, and others)

Chapter 15. Sedation in Children with Cerebral Palsy in the Early Postoperative Period after Single-Event Multilevel Orthopedic Surgery
(Vadim Evreinov, MD, and Grigory Mukhametdinov, MD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 16. Spinal Pathology in Cerebral Palsy
(Sergey Ryabykh, MD, PhD, Alexander Gubin, MD, PhD, Dmitry Savin, MD, PhD, Polina Ochirova, MD, PhD, Tatyana Ryabykh, MD, and Olga Sergeenko, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 17. Surgical Correction of Spinal Deformity due to Cerebral Palsy in Children and Adults
(Sergey Ryabykh, MD, PhD, Alexander Gubin, MD, PhD, Dmitry Savin, MD, PhD, Polina Ochirova, MD, PhD, Tatyana Ryabykh, MD, and Olga Sergeenko, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

Chapter 18. Results of Reconstructive Surgery in Upper Limb in Patients with Cerebral Palsy
(Georgy Chibirov, MD, PhD, Mairbek Pliev, MD, and Dmitry Popkov, MD, PhD, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russia)

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