Orthopaedic Management in Cerebral Palsy: A Narrative Review
Made Agus Maharjana
Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Kenny Gozal *
Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Background: Cerebral palsy (CP) is a permanent disorder of movement and posture caused by a non-progressive injury to the developing brain. Despite the static nature of the neurological insult, musculoskeletal complications often progress with growth, leading to spasticity, contractures, skeletal deformities, hip instability, gait abnormalities, and spinal deformities that may significantly limit function and quality of life.
Aims: This review aims to summarize key principles of orthopaedic management in CP and highlight practical approaches for clinical assessment, surveillance, and treatment planning to optimize function and prevent secondary deformities.
Methods: A narrative review was conducted using published literature focusing on the definition and classification of CP, diagnostic evaluation, hip surveillance, gait assessment, and orthopaedic interventions. Both conservative and surgical strategies were included, with emphasis on decision-making frameworks used in contemporary clinical practice.
Results: Orthopaedic management in CP is best delivered through a multidisciplinary approach. Non-operative measures such as physiotherapy, orthoses, serial casting, and spasticity control are essential to maintain range of motion, improve alignment, and enhance functional performance. Surgical intervention is indicated for fixed deformities, progressive hip displacement, severe gait dysfunction, and scoliosis, with single-event multilevel surgery increasingly applied to correct multiple deformities in one operative session. Ongoing clinical evaluation, standardized hip surveillance, and gait analysis support timely intervention and improved outcomes.
Conclusion: Orthopaedic care plays a central role in improving mobility, reducing pain, and enhancing quality of life in children with CP. Individualized treatment based on functional classification, careful surveillance, and appropriately timed conservative or surgical interventions is critical to achieve optimal long-term outcomes.
Keywords: Cerebral palsy, orthopaedic management, spasticity, hip surveillance