Bony Procedures

Arthrodesis is the process of fusing a joint - this means it will become stiff and will no longer move. The most common joint fused in cerebral palsy is the wrist. A total wrist fusion is typically used to correct a very severe deformity in older children or adults who have limited function and who have finished growing. 

In younger children a mid carpal, limited fusion or a growth plate sparing fusion may be considered.  

Fusion is also sometimes performed in the thumb to correct an unstable joint and may be done in combination with a thumb tendon transfer or re-routing. 

In very rare cases where the shoulder joint is subluxed and painful, a shoulder fusion may be considered.

A proximal row carpectomy (PRC) is a surgical procedure that is generally used for severe flexion contractures of the wrist. 

The wrist is composed of multiple small bones known as carpal bones, which are arranged in two rows: the proximal row (yellow) and the distal row (green).

During a proximal row carpectomy, the bones in the proximal row (yellow) of the wrist are removed. By removing the bones it makes the overall bone length shorter and thereby making the muscles relatively longer. This can make it easier to correct the position of the wrist. 

PRC is often performed in combination with other procedures such as tendon transfers or wrist fusion. 

Osteotomy is a surgical procedure that involves cutting and reshaping bone. It may be performed for many reasons including to  correct bone deformities, mal-alignment or to improve function. 

It is important to understand that osteotomy doesn't usually improve the range of motion. It simply moves the arc of motion or moves the limb into a more functional position. 

An example is a de-rotation osteotomy of the humerus or forearm.