Surgical management of the hand in infantile spastic hemiplegia.

Selected spastic patients with cerebral palsy can be helped by peripheral reconstructive surgery, of the upper limb. Although surgery cannot make a limb that was functionally poor into a perfect one, it can greatly improve the preoperative condition. Most poor surgical results are caused by incorrect selection of patients or poor execution of surgical procedures. The worst mistake is to perform soft tissue procedures--tendinous release or tendinous transfers--on a patient with pure athetosis. The results in these cases are unpredictable and often fail. The same concept is applied to rigidity, hypotonia, dystonia, and ataxia. The surgical program is organized according to the type and severity of the deformity (clinical groups). The goals are to correct the deformities and to improve the muscular balance of the hand in one surgical stage. It must be remembered that spastic muscle cannot be used for tendon transfer with the same efficiency as in patients with a flaccid paralysis. Results were satisfactory in 92% of cases of groups I and II. If group III is included, the percentage of satisfactory results reduces significantly.