Bone deformities in patients with cerebral palsy

Patients with spastic cerebral palsy (sCP) typically present with an impaired
range of motion that affects the positioning of the upper extremity. The motor
disorders of sCP are often accompanied by secondary musculoskeletal problems
(Rosenbaum et al., 2007) which limit the functioning of the hand and arm.
Generally, the extreme wrist flexion and ulnar deviation position develops well
before adolescence. Consequently, the bones of the wrist develop under
pathological loads.
The proximal carpal bones play important roles in the mobility of the wrist
(Craigen and Stanley, 1995, Garcia-Elias et al., 1995). Relations have been
found between the bone shapes and their kinematics (Nakamura et al., 2000). In
the area of reconstructive surgery, the ability to recover functional wrist
mobility depends on the estimated non-pathological bone shapes (Craigen and
Stanley, 1995, Crisco et al., 2005). Recently, a statistical shape model has
been developed with which the shapes of the bones of the wrist can be described
using CT scans (van de Giessen et al., 2010, van de Giessen et al., 2011). With
these descriptions, we can study the influence of spastic control on bone
growth in the spastic wrist. Ultimately, this information can tell us something
about the development of postoperative wrist pain in sCP patients.
The aim of our study is to evaluate the degree of anatomical variation of the
wrist bones as a consequence of spastic control. We also want to compare degree
of anatomical variation with that of the unaffected wrist.

The aim of this study is to evaluate the influence of extreme fixed wrist
flexion and ulnar deviation due to spasticity on bone shapes of the wrist
bones. We want to compare CT scan-based three-dimensional reconstructions of
the spastic wrist to the contralateral, healthy wrist in hemiplegic patients.
We hope to gain valuable anatomical information and to create a basis for
further research in studies on various wrist pathology and surgical techniques.

An observational study and anatomical study.

The radiation exposure of scans is estimated to be 0,6 mSv for each
participant. This is comparable to 12-14 weeks background exposure to the
natural radiation in The Netherlands.