(ii) The management of spastic diplegia

A consequence of improved survival of very premature babies is increasing numbers of children presenting to Orthopaedic surgeons with spastic diplegia. The majority of these children can walk but gait abnormalities are common and the natural progression is from muscle spasticity to contracture and eventual bony deformity, This results in increasingly inefficient gait as the child grows and gains weight. Intervention is initially by spasticity management, enhanced (over recent years) since the advent of Botulinum toxin type A, and later surgical intervention to both contracted muscles and bony deformities. Instrumented gait analysis is a prerequisite of surgery and all deformities should be addressed simultaneously Surgery should only be considered once the child's function has plateaued, usually between the age of seven and ten, Satisfactory results require patient and carer compliance in what is an intensive rehabilitation involving a multidisciplinary approach. (C) 2003 Elsevier Science Ltd. All rights reserved.