Define Cerebral Palsy — Orthopaedic Aspects. Describe its classification and management.

Definition

Cerebral palsy (CP) is a non-progressive disorder of movement and posture caused by a static lesion of the immature (developing) brain. Although the brain lesion itself does not progress, its musculoskeletal consequences — spasticity, contractures, deformity and hip displacement — do progress with growth, which is where orthopaedic care is central.

Classification

CP is classified by the type of movement disorder — spastic (the commonest, upper-motor-neuron), dyskinetic/athetoid, ataxic or mixed — and by the anatomical distribution (hemiplegia, diplegia, quadriplegia). Functional ability is graded by the Gross Motor Function Classification System (GMFCS, I–V), which strongly guides expectations and management.

Musculoskeletal Problems

Spasticity produces characteristic patterns: at the hip, flexion, adduction and internal rotation with a tendency to progressive hip subluxation/dislocation (which must be monitored by ‘hip surveillance’ radiographs); at the knee, flexion contractures and a crouch gait; at the ankle/foot, equinus and equinovarus/valgus; and, in the spine, neuromuscular scoliosis. Fixed contractures follow chronic spasticity.

Management

Care is multidisciplinary and lifelong, aimed at maximising function, comfort and independence rather than ‘cure’. It includes physiotherapy and occupational therapy, orthoses (e.g. Ankle-foot orthoses), and spasticity management (botulinum toxin injections, oral agents, intrathecal baclofen, and selective dorsal rhizotomy in selected children). Orthopaedic surgery — soft-tissue releases/lengthenings, tendon transfers, bony osteotomies for hip displacement, and scoliosis correction — addresses fixed deformities, often performed together as single-event multilevel surgery in ambulant children.

Aetiology & Associated Problems

The static brain lesion of cerebral palsy may arise antenatally (the majority — prematurity, intrauterine infection, malformation), perinatally (hypoxic-ischaemic injury, birth asphyxia) or postnatally (kernicterus, meningitis, head injury in early life). Beyond the motor disorder, affected children commonly have associated impairments — learning difficulty, epilepsy, visual and hearing deficits, speech and feeding difficulties, and gastro-oesophageal reflux — which is why care is delivered by a broad multidisciplinary team and orthopaedic decisions are made in the context of the whole child.

Assessing Gait & Function

In ambulant children, systematic assessment (including instrumented gait analysis where available) identifies which deformities are the true drivers of dysfunction, distinguishing dynamic spasticity from fixed contracture. This underpins the modern strategy of single-event multilevel surgery, correcting all significant levels in one operative episode to limit repeated anaesthetics and rehabilitation, and preserving energy-efficient walking.

The brain lesion is static but the musculoskeletal deformity progresses.

• Non-progressive brain lesion → progressive musculoskeletal deformity with growth.
• Classified by movement type (spastic commonest) & distribution; function graded by GMFCS.
• Hip subluxation, contractures, equinus foot, neuromuscular scoliosis; do hip surveillance.
• Multidisciplinary lifelong care; spasticity management + orthoses + selective surgery.
• Aim is function & comfort, not cure; single-event multilevel surgery for fixed deformities.