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Role of orthopedic surgery

Decision more important than


incision
Orthopedic surgery
Avoid birthday syndrome
SEMS single event multiple surgery
Good results if
A) age appropriate done particularly during growth
spurt
B) balance at least must be able to kneel.
C) cognition must be able to understand reasoning
behind the programme and the instructions given.
D) disability must have sufficient strength and
control that when joints are realigned and soft
tissues released the child would be able to benefit
fro surgery.
E) emotion must be sufficiently mature to be able
to undergo the stress involved in extensive surgery
and rehabilitation which may last 6 months to a
year.
Orthopedic surgery
Procedures to lengthen contracted myotendinous units,
Balance joint forces,
Transfer motor power,
Fuse unstable joints, (arthrodesis)
Correct bony deformity, (to improve biomechanical
alignement)
Reduce joint subluxation and dislocation (to improve joint
congruety)
Diminish painful spasticity
Maintain ,restore or stabilise spinal deformity.Procedures
only if progressive deformity producing paiin or interfering
with function, fixed contracture ,joint subluxation or
dislocation, refractory spinal deformity, and deformity
preventing adequate administration of care.
Orthopedic surgery

Procedures are-
Neurectomy, tenotomy,
Arthrodesis,osteotomy, ostectomy,
Tendon transfer, tendon tenthening,
Fractional myotendinous lengthening,
Multisegmental spinal fusion or a
combination of these procedures.
Orthopedic surgery
Soft tissue surgeries around 6-7 years of age,
unless hip is subluxating then early.
Bony surgeries around 10 years and more.
Lever arm dysfunctions adressed at that time.
Good results in children with spasticity, prognosis
guarded with those with mixed cerebral palsy or
those with involuntary movements.
To improve gait pattern in the ambulatory child
To achieve good sitting in the child who is house-
hold walker
To achieve perenial hygeine in those who have
difficulty for nursing, positioning
Orthopedic surgery
Oga/or gait analysis done, pci done with without
aids
At hip pelvic and femoral osteotomies, generally
vdro varus derotation osteotomy for internal
rotation deformity, ilio-psoas release, adductor
tenotomy anterior branch neurectomy, rectus
release, rectus transfer to it band, surpacondylar
extension osteotomy
Medial and lateral hamstring release
Supramalleolar tibial osteotomies.
Tendoachilles lenthening, peronei release,tib ant,tib
post transfer, grices extra articular arthrodesis.
Adductor hallucis release, metatarsal osteotomies,
arthrodesis
Orthopedic surgery

In upper limb lengthening


of pectoralis major,or subscapularis
tendons, or both,transfer of
lattissimus dorsi and teres major to
lateral humerus,humeral osteotomy,
Brachialis fractional lengthening,z-
plasty of biceps, flexor-pronator slide,
release of elbow capsule.
Orthopedic surgery
Pronator tenotomy, lengthening,
Rerouting of pronator teres,
Pronator flexor slide,
Fcu transfer 4th metacarpal, (to finger extensors,
Proximal row carpectomy,
Release of adductor pollicis, first dorsal
interosseus or both, transfer of adductor insertion
to the metacarpal, lengthening or reinforcement of
flexor pollicis longus,
Plication, rerouting, or reinforcement of the
extrinsic thumb extensors and abductors.
Orthopedic surgery

Spinal stabilizations in children/adults


with neck, back pain, scoliosis,(25%
in c.p, 60-75% in those with tbi)
kyphosis,radiculopathy especially
those with athetosis, dystonia.