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paediatric

Cerebral Palsy: Orthopaedic Management

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 7-year-old girl with spastic diplegic cerebral palsy is referred for gait assessment. She was born at 28 weeks gestation with periventricular leukomalacia. She walks with a posterior walker and can take some independent steps. Her parents are concerned about worsening crouch gait and increased toe-walking. She has previously had botulinum toxin injections to her calf muscles. On examination, she has bilateral hip flexion contractures of 20 degrees, popliteal angles of 60 degrees bilaterally, and ankle dorsiflexion of -10 degrees with knee extended.
Clinical photograph of a 7-year-old child with spastic diplegic cerebral palsy demonstrating typical gait pattern. There is bilateral hip flexion, adduction, and internal rotation (scissoring). The knees are flexed (crouch gait) with equinus at the ankles. The child uses a posterior walker for support. GMFCS Level III. This pattern is amenable to single-event multilevel surgery (SEMLS).
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Clinical photograph of a 7-year-old child with spastic diplegic cerebral palsy demonstrating typical gait pattern. There is bilateral hip flexion, adduction, and internal rotation (scissoring). The knees are flexed (crouch gait) with equinus at the ankles. The child uses a posterior walker for support. GMFCS Level III. This pattern is amenable to single-event multilevel surgery (SEMLS).

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the GMFCS classification and its clinical relevance.

Question 2 (5 marks)

Explain the hip surveillance program and management algorithm.

Question 3 (6 marks)

Describe the principles of single-event multilevel surgery (SEMLS).

Question 4 (5 marks)

What are the non-surgical management options for spasticity?

Question 5 (4 marks)

How do you assess and manage equinus deformity?

Question 6 (4 marks)

What is the role of gait analysis in surgical planning?

Exam Day Cheat Sheet

Must Mention

  • •GMFCS I-V classification
  • •Hip surveillance with migration percentage
  • •MP 30% = soft tissue, MP 40-60% = bony
  • •SEMLS after gait analysis (age 6-12)
  • •Silfverskiold test for equinus
  • •Botox for dynamic, surgery for fixed

Common Pitfalls

  • •Missing hip surveillance
  • •Wrong GMFCS levels
  • •Wrong MP thresholds
  • •No gait analysis mention
  • •Wrong Silfverskiold test
  • •Missing SEMLS concept