managent

Upper Limb

Upper limb surgery is mainly in spastic hemiplegia

- many of the CP' s have sensory neglect for affected limbs

- won't use limb post surgery anyway

Surgical indications

- a reasonable level of IQ (>70)

- spastic not athetoid

- voluntary grasp and release

Distal tibia

- appears by 2 years

- closed at maturity

- asymmetrical closure

- central initially, then posteromedial to anterolateral

- accounts for Tillaux and Triplanar fractures

Distal fibula

- appears by 2 years

- closes 2 years after distal tibia

Medial Malleolar Extension

- begins age 7

- closes age 10