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Surgical Management of the Lower Extremity in Ambulatory Children With Cerebral Palsy

Dr. Karol is Associate Professor, University of Texas Southwestern Medical School, and Staff Orthopaedist, Texas Scottish Rite Hospital for Children, Dallas, TX.

Reprint requests: Dr. Karol, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219.

Despite the increasing popularity of nonorthopaedic treatment alternatives for children with cerebral palsy, bony and soft-tissue surgery remains a common component in the management of ambulatory patients. Multisite simultaneous tendon surgery provides improvement in gait by addressing hip, knee, and ankle contractures together. Careful preoperative physical examination is required; computerized gait analysis can be useful in confirming a plan for multiple tendon surgeries. Rotational osteotomies can improve transverse-plane malalignment. Shorter periods of immobilization and aggressive postoperative gait training and strengthening may optimize improvements in gait.