Email this article Conservative treatment of pronational contracture of the forearm in children with cerebral palsy
- Authors: Novikov V.A.1, Umnov V.V.1, Zvozil A.V.1, Umnov D.V.1, Nikitina N.V.1
-
Affiliations:
- The Turner Scientific Research Institute for Children’s Orthopedics
- Issue: Vol 6, No 1 (2018)
- Pages: 33-38
- Section: Original papers
- URL: https://bakhtiniada.ru/turner/article/view/8388
- DOI: https://doi.org/10.17816/PTORS6133-38
- ID: 8388
Cite item
Abstract
Aim. We aimed to evaluate the effectiveness of conservative treatment for pronational contracture of the forearm, depending on the contracture severity.
Materials and methods. This study was based on the results of the examination and treatment of children experiencing cerebral palsy with upper limb involvement. The main criterion for patient selection was the presence of pronational contracture of the forearm, both isolated and in combination with other contractures in the upper limb joints. Three patient groups were formed based on the pronounced pronation contracture of the forearm.
Results and conclusions. Previous research has established that with the increase in the degree of severity of pronation contracture, the effectiveness of conservative treatment decreases in general. Conservative treatment of patients with a deficiency of active supination of the forearm of > 90° is ineffective. The use of botulinum toxins type A and RFD in groups II and III is ineffective. Conservative treatment with botulinum toxins type A achieved good results only in patients of group I.
The RFD method had a longer lasting; however, there were significantly more complications. The use of botulinum toxins type A (m. pronator teres) among patients with pronational contracture of the forearm with the possibility of active supination of the forearm > 90° significantly improved the result of basic conservative treatment.
Full Text
##article.viewOnOriginalSite##About the authors
Vladimir A. Novikov
The Turner Scientific Research Institute for Children’s Orthopedics
Author for correspondence.
Email: umnovvv@gmail.com
MD, Research Associate of the Department of Infantile Cerebral Palsy
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Valery V. Umnov
The Turner Scientific Research Institute for Children’s Orthopedics
Email: umnovvv@gmail.com
MD, PhD, Professor, Head of the Department of Infantile Cerebral Palsy
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Alexey V. Zvozil
The Turner Scientific Research Institute for Children’s Orthopedics
Email: zvosil@mail.ru
MD, PhD, Senior Research Associate of the Department of Infantile Cerebral Palsy
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Dmitry V. Umnov
The Turner Scientific Research Institute for Children’s Orthopedics
Email: dmitry.umnov@gmail.com
MD, PhD, Research Associate of the Department of Infantile Cerebral Palsy
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Natalia V. Nikitina
The Turner Scientific Research Institute for Children’s Orthopedics
Email: dmitry.umnov@gmail.com
MD, Chief of the Department of Infantile Cerebral Palsy
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603References
- Новиков В.А., Умнов В.В., Звозиль А.В. Хирургическое лечение пронационной контрактуры предплечья у пациентов с детским церебральным параличом // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2014. – Т. 2. – № 1. – С. 39–45. [Novikov VA, Umnov VV, Zvozil’ AV. Surgical treatment of pronation contracture of the forearm in patients with infantile cerebral palsy. Pediatric traumatology, orthopaedics and reconstructive surgery. 2014;2(1):39-45. (In Russ.)]
- Новиков В.А., Умнов В.В., Звозиль А.В. Тактика лечения сгибательной контрактуры лучезапястного сустава у детей с детским церебральным параличом // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2014. – Т. 2. – № 3. – С. 40–46. [Novikov VA, Umnov VV, Zvozil’ AV. Treatment strategy of flexion contracture of the wrist joint in children with cerebral palsy. Pediatric traumatology, orthopaedics and reconstructive surgery. 2014;2(3):40-46. (In Russ.)]
- Умнов В.В., Заболотский Д.В., Звозиль А.В., и др. Детский церебральный паралич. Эффективные способы борьбы с двигательными нарушениями. – СПб., 2013. [Umnov VV, Zabolotskiy DV, Zvozil’ AV, et al. Cerebral palsy. Effective ways of dealing with movement disorders. Saint Petersburg; 2013. (In Russ.)]
- Умнов В.В., Новиков В.А. Диагностика и лечение спастической руки у детей с детским церебральным параличом: состояние вопроса по данным мировой литературы. Часть I. Оценка состояния верхней конечности у детей с детским церебральным параличом // Травматология и ортопедия России. – 2010. – № 1. – С. 124–130. [Umnov VV, Novikov VA. Diagnostics and treatment of spastic hand in children with infantile cerebral paralysis: the review. Part 1. the assessment of upper extremity state. Travmatologiia i ortopediia Rossii. 2010;(1):124-130. (In Russ.)]
- Dahlin LB, Komoto-Tufvesson Y, Salgeback S. Surgery of the spastic hand in cerebral palsy. Improvement in stereognosis and hand function after surgery. J Hand Surg Br. 1998;23(3):334-339. doi: 10.1016/s0266-7681(98)80053-3.
- Miller F. Cerebral palsy. New York; 2005.
- Бадалян Л.О. Детская неврология. – М.: МЕДпресс-информ, 2001. [Badalyan LO. Pediatric neurology. Moscow: MEDpress-inform; 2001. (In Russ.)]
- Ozkan T, Bicer A, Aydin HU, et al. Brachialis muscle transfer to the forearm for the treatment of deformities in spastic cerebral palsy. J Hand Surg Eur Vol. 2013;38(1):14-21. doi: 10.1177/1753193412444400.
- Ozkan T, Tuncer S. [Tendon transfers for the upper extremity in cerebral palsy]. Acta Orthop Traumatol Turc. 2009;43(2):135-148. doi: 10.3944/AOTT.2009.135.
- Ненько А.М. Хирургическое лечение контрактур и деформаций верхней конечности у детей с церебральными параличами: Автореф. дис. ... канд. мед. наук. – СПб., 1992. [Nen’ko AM. Surgical treatment of contractures and deformities of the upper limb in children with cerebral palsy. [dissertation] Saint Petersburg; 1992. (In Russ.)]
- Cheema TA, Firoozbakhsh K, De Carvalho AF, Mercer D. Biomechanic comparison of 3 tendon transfers for supination of the forearm. J Hand Surg Am. 2006;31(10):1640-1644. doi: 10.1016/j.jhsa.2006.09.005.
- Gschwind C, Tonkin M. Surgery for cerebral palsy: Part 1. Classification and operative procedures for pronation deformity. J Hand Surg Br. 1992;17(4):391-395. doi: 10.1016/s0266-7681(05)80260-8.
- Тупиков В.А. Способы хирургической коррекции пронационного компонента контрактур суставов верхней и нижней конечности у детей с детским церебральным параличом // Вестник травматологии и ортопедии им. Н.Н. Приорова. – 2009. – № 1. – С. 53–57. [Tupikov VA. Techniques for Surgical Correction of Pronation Component of Upper and Lower Extremities Joint Contractures in Children with Infantile Cerebral Paralysis. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2009;(1):53-57. (In Russ.)]
- Roth JH, O’Grady SE, Richards RS, Porte AM. Functional outcome of upper limb tendon transfers performed in children with spastic hemiplegia. J Hand Surg Br. 1993;18(3):299-303. doi: 10.1016/0266-7681(93)90045-h.
- Sakellarides HT, Mital MA, Lenzi WD. Treatment of pronation contractures of the forearm in cerebral palsy by changing the insertion of the pronator radii teres. J Bone Joint Surg Am. 1981;63(4):645-652. doi: 10.1097/01241398-198112000-00059.
- Veeger HE, Kreulen M, Smeulders MJ. Mechanical evaluation of the Pronator Teres rerouting tendon transfer. J Hand Surg Br. 2004;29(3):259-264. doi: 10.1016/j.jhsb.2004.01.004.
- Strecker WB, Emanuel JP, Dailey L, Manske PR. Comparison of pronator tenotomy and pronator rerouting in children with spastic cerebral palsy. The J Hand Surg Am. 1988;13(4):540-543. doi: 10.1016/s0363-5023(88)80091-1.
- Van Heest AE, Sathy M, Schutte L. Cadaveric modeling of the pronator teres rerouting tendon transfer. J Hand Surg Am. 1999;24(3):614-618. doi: 10.1053/jhsu.1999.0614.
Supplementary files
