Orthopedic lower limb deformities in cerebral palsy: A case series

Introduction: One-third of children with cerebral palsy (CP) do not yet walk at the age of 5. Orthopedic deformity is one of the pathologies that may compromise the efficiency of gait in those patients. The aim of our study was to describe the clinical characteristics of orthopedic deformities for CP patients and to describe device prescription to manage the deformities. Methods: A retrospective chart review was conducted at the Equipment Teaching Hospital of Madagascar, after ethic committee approval, during a period of 1 year, from the beginning of January 2017 to the end of December 2017. Patients diagnosed with CP, during the period of the study, regardless of age and gender, were included in the study. Incomplete patients' records have been excluded from the study. The different types of orthopedic deformities were analyzed. Results: New cases of CP were in the order of 5.61% (n = 100) in 1783 new patients seen in consultation during 2017. Ninety-five patients were kept out. Eighty-nine percent of patients reported to the hospital after 12 months of age. Orthopedic deformity was detected in 48 patients, including 27.36% with deformity of the foot, 5.26% of the knee, 4.21% of the hip, and 16.84% of the spine. More than 73% of the patients had spasticity. In 45.26% of the cases, patients with CP had a complete functional restriction with a Gross Motor Function Classification System V (GMFCS), and only 27 patients had GMFCS I or II. In 82.1% of the cases, patients with CP needed devices to reduce their deficit or maintain functional gain. Conclusion: CP is a public health problem. Orthopedic deformities are often discovered late, affecting the gait quality for these patients. Orthopedic deformities prevention is crucial, and multidisciplinary care should be done early.