Results of thumb-in-palm deformity surgery combined with arthrodesis of the wrist in cerebral palsy children with severe deformities

Abstract

Introduction Thumb-in-palm adduction and wrist flexion contractures are the most frequently encountered deformities of the upper extremity in patients with severe spastic paralysis. When deformities are severe, ease of personal care, skin hygiene, hand function and appearance are adversely affected. Several surgical options have been described for thumb-in-palm deformity. The aim of this study was to assess the results of the thumb-in-palm deformity surgery combined with arthrodesis of the wrist in CP children with severe deformity. Material and methods Eleven patients operated for severe spastic contracture of the hand and the wrist were evaluated. Wrist arthrodesis was realized in all cases. Radiographs were performed to analyze the union rate and the flexion deformity. According to the thumb-in-palm deformity, 6 lengthening, 1 adductor release, 2 tenodesis and 2 arthrodesis were realized. The patients were subjectively evaluated using the Disability Assessment scale (DAS) and a visual analog scale assessing appearance, function, hygiene, ease of daily care, pain and overall satisfaction. Results The average age of patients and follow-up was respectively 18 years at the time of surgery and 28 months. The mean radiographic flexion deformity significantly improved from 77° preoperatively to 4° of dorsal angulation postoperatively. The DAS improved significantly from a preoperative mean of 9.2 to a postoperative mean of 4.5. Visual analog scale demonstrated improvements in different conditions. The functional house score improved but the thumb-in-palm deformity was more pronounced in 6 patients after the surgery and two patients required a second surgery. Discussion The thumb-in-palm is a true obstacle to use of the hand in patients with severe spastic paralysis. When the deformity of the thumb is important, the soft tissues surgery may be inadequate and the arthrodesis of the thumb in a functional position is a good option. Conclusion The treatment of thumb-in-palm deformity is difficult in severe CP children. The thumb and wrist disorders have to be treated in one stage with a surgical plan established to improved the function needed in patients with severe contracture.