Management of equinus in cerebral palsy

ABSTRACT

The equinus accompanying cerebral palsy occurs as a result from tendo calcanius contracture, which results in difficulty in dorsal flexion of foot in ankle joint. The goals of this research are A-selection of appropriate management for the equinus in cerebral palsy. B-the possibility of reducing the complication rate; as infections, recurrence and aggravation of deformity. C-definition of the ideal timing for such procedures. A-significant frequency of these cases. B-diagnosis accuracy, especially in early aged-patients. C-definition of the ideal timing for the management, either conservative or surgical. There were/50/cases of equinus in cerebral palsy documented in/28/patients, who followed up for/14/months approximately/from 6 to 26 months/Male for female 31, ratio was/males were 21 patients, werease females were71. The cases were classified on basis of central nervous system development, into two groups; A-first group/7 years or less/B-second group/older than 7 years/All the data related to those patients are obtained from their files. The cases which were not complete documented have ruled out. Subsequent follow up carried out during the period mentioned above. -Males percentage in this study was/71.4%/whereas females accounted for/28.6%/. -There were two age subdivisions one under/7/years, and the other was older than that. -All studied cases accounted for/50/, 36 cases have classified as first subdivision/72%/, and the rest of the cases/14/cases/has classified as the second one/28%/-Patients age average was 8.053 years. The youngest one has aged two years, and the oldest was 26 years. -The most potential diagnostic technologies were clinical when diagnosis of equines and cerebral palsy was firmly established. -Conservative management was carried out in 7 cases only; all of them were first subdivision. Surgical intervention was carried out in 43 patients from both of the subdivision. Conservative management included periodic casts for/3-6/months, and then followed by AFO until long bones growth is completed. -Surgical procedures varied, the simplest one was elongation of tendo calcanius in z-shape with or without medial and posterior capsulotomy the, percentage was 44.1% in 19 equnius cases. -The results which have been observated were as the following A-GOOD RESULTS: the equnius deformity was corrected completely in 4. foots/which means 80% from all studied foots/B-MODEATE RESULTS: in these cases the equnius deformity was corrected in spite of the presence of mild pain during walking in 6 foots/12% of all studied foots/C-BAD RESULTS: the deformity has not corrected and there were claudation and moderate to sever pain in 4 foots/8% of all studied foots/Postoperative Complications Were A-Osteoarthritis in 12 foots/24%/. B-Scarring in 4 foots/9.3%/. C-Wound infection in 6 foots/13.9%/. D-recurrence in 7 foots/14%/. E-skin necrosis in 3 foots/6.9%/. F-two foots had abscesses/4.6%/. G-chonic pain in 4 foots/8%/. -This study of Aleppo University Hospital was compared with two studies; the first was carried out in Saint-Etheian University-France/2000/and Carl-Francis-Gras, Austria./2000/. -The studied cases in the both studies accounted for 48 foots, 28cases were treated surgically, and the rest conservatively. -The procedures have undergone in those centers were Z-PLASTY, VALPIUS, STRAYER, BAKER, and the most common procedure was VALPIUS in 7 patients who had I.foots with deformity/35.7%/