Turn on cookies to sign in
Signing in saves your progress to your Curie account. We can only do that with cookies on — turn them on to continue.
When bracing and botulinum toxin weren't enough, surgeons turned to a combined bone-and-soft-tissue approach to help a 20-year-old with spastic cerebral palsy. A proximal row carpectomy paired with wrist arthrodesis and tendon lengthening successfully corrected a severe right upper extremity contracture. The result? Easier hygiene, dressing, and daily care — with a very satisfied family.
A 20-year-old man with spastic quadriplegic cerebral palsy (GMFCS level 5) had exhausted nonoperative options — physical therapy, bracing, and botulinum toxin injections — yet still developed severe fixed flexion deformities of his right upper extremity. His wrist was flexed to 90° with limited passive correction, making basic hygiene and caregiving extremely difficult. Surgeons at Olympia Fields Hospital in Chicago opted for a combined surgical approach, with the goal not of restoring active function, but of improving limb positioning for daily care.
The procedure combined elbow flexor lengthening (biceps tenotomy and brachialis fractional lengthening), wrist and finger flexor releases, proximal row carpectomy, and wrist arthrodesis using a fusion plate fixed in slight extension. Autologous bone graft was used to support fusion. At 2-month follow-up, imaging confirmed stable fixation with no complications, and the family reported dramatically improved ability to perform hygiene and dressing.
Key Takeaways:
Why it matters: For patients with severe spastic cerebral palsy who have no baseline limb function, surgery is often overlooked — but this case demonstrates that targeted orthopedic intervention can meaningfully improve quality of life for both patients and their caregivers.
