الفهرس 
Anatomy and BiomechanicsOnly 14 pages are availabe for public view
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Abstract
Background: Cerebral palsy is the musculoskeletal manifestation of a non progressive central nervous system lesion that usually occurs due to a perinatal insult to the brain. Though the cerebral insult is static the musculoskeletal pathology is progressive. Spasticity leads to shortening of musculoskeletal units, which in turn causes fixed contractures and eventually leads to torsional abnormalities of long bones, joint instability, deformities, and degenerative arthritis.
Aim of the work: The purpose of this study is to evaluate the short term results of treatment of thumb- in- palm deformity in children with cerebral palsy treated by various surgical reconstruction of the thumb.
Subjects and methods: This prospective study that included 30 patients diagnosed as spastic cerebral palsy with thumb-in palm deformity with an age 4-12 years who were assessed and operated at the orthopedic department, National neuromotor institute of Egypt through two years. CP with thumb-in palm deformity with congenital, stroke, brain injury or post traumatic causes and CP children with dystonia or extrapyramidal manifestations were excluded from the study. All patients included in the study were subjected to preoperative evaluation including perinatal history, questionnaire for functional ability, detailed general and neurological examination with evaluation of the deformity according to static house classification system at which operative interference was selected. Pre and post manual ability classification system (MACS), spontaneous functional analysis (SFA) of the thumb. Dynamic positional analysis (DPA) of the thumb were used for assessment of the patients.
Results: Our study showed a description for the 30 spastic CP children with thumb-in-palm deformity including their age, sex with insignificant predominance of the male gender, etiology of CP was referred to anoxia, prematurity, jaundice. Hemiplegic type of CP dominated diplegic type in our thesis with unilateral affection rather than bilateral affection. According to static house classification:one patient (3.33%) was type I, sixteen patients (53.33%) were type II, eight patients (26.67%) were type III and five patients (16.67%) were type IV on which surgical methods for correcting these deformities were based. In all types thumb web z-plasty /fascial release, adductor release in palm, first dorsal interosseous release, and extensor pollicis longus rerouting operations were done. In type-2 added flexor pollicis brevis release. In type-3 added MCP capsulodesis. In type-4 added flexor pollicis brevis release and FPL lengthening. There was improvement of the function of the hand among the study group as reflected by the statically significant improvement of postoperative MACS scaling, SFA of the study group. The position of the thumb was improved postoperatively as reflected by the improvement of DPA postoperatively.
Conclusion: from the course of this study; we can conclude that the surgical correction of spastic thumb-in-palm deformity includingZ plasty / fascial release, 1st dorsal interoseous release, extensor pollicis longs rerouting, adductor pollicies release were done for all patients, flexor pollicis brevis release was done in type-2 of the cases, The MCP joint capsulodesis was done in type-3 of the cases and flexor pollicis longus lengthening was performed in type-4 of the cases,yields improved functional outcome at the short time. Thus, we recommend application of more studies to analyse the benefit of surgical interference based on the precise clinical assessment of thumb-in palm deformity.