What Is Cerebral Palsy?
Cerebral palsy (CP) describes a group of permanent but non-progressive disorders of movement and posture resulting from a disturbance in the developing fetal or infant brain. It is the most common cause of physical disability in childhood. The underlying brain injury does not worsen over time, but the musculoskeletal manifestations — including contractures, bony deformity, and joint problems — can evolve significantly as the child grows.
CP is classified by the predominant movement disorder (spastic, dyskinetic, or ataxic) and by the distribution of involvement (hemiplegia, diplegia, quadriplegia). Spastic CP — characterised by increased muscle tone and exaggerated reflexes — accounts for approximately 80% of cases and is the form most frequently requiring orthopaedic intervention.
Orthopaedic Complications & Goals of Treatment
The principal role of orthopaedic surgery in CP is to address the secondary musculoskeletal consequences of abnormal muscle tone and movement — preventing painful complications and optimising function.
Hip Displacement
Progressive subluxation or dislocation of the hip is a major concern, particularly in non-ambulant children. Regular hip surveillance with X-rays allows early detection and timely intervention.
Gait & Lever Arm Problems
Abnormal muscle tone causes crouch gait, intoeing, and other gait deviations that impair efficiency and increase energy expenditure. Osteotomies can address rotational and angular deformities.
Foot Deformity
Equinus (toe-walking), equinovarus, and planovalgus foot deformities are common and affect standing balance, shoe fitting, and ambulation.
Treatment Options
Management of CP is inherently multidisciplinary, involving orthopaedic surgeons, neurologists, rehabilitation physicians, physiotherapists, occupational therapists, and orthotists. Surgical intervention is carefully timed in the context of the child’s growth and functional development.
- Botulinum toxin A (Botox) — temporary reduction in muscle spasticity, used in younger children to improve function and delay the need for surgery; effects last three to six months
- Orthotics (AFOs and other splints) — provide support, correct position, and prevent contracture development
- Serial casting — gradual stretching of contracted muscles, particularly the gastrocsoleus, to improve passive range of motion before surgical correction
- Tendon lengthening and transfer — surgical correction of contractures (hamstring, iliopsoas, gastrocsoleus) to improve posture and gait
- Bony osteotomies — correction of femoral and tibial rotational deformities and angular malalignment
- Hip reconstruction — for progressive hip displacement; femoral and pelvic osteotomies to restore and maintain hip containment
- Single-event multilevel surgery (SEMLS) — combining multiple procedures in a single operative event to minimise the total number of hospitalisations and anaesthetics
Discuss Cerebral Palsy Management
For a personalised assessment and treatment plan, contact Dr. Pirpiris’s rooms at Cabrini Medical Centre, Malvern.
📞 Call 03 9508 9600