The Baumann procedure for fixed contracture of the gastrosoleus in cerebral palsy

Abstract

We treated 22 children (28 limbs) with diplegic cerebral palsy who were able to walk by the Baumann procedure for correction of fixed contracture of the gastrosoleus as part of multilevel single-stage surgery to improve gait. The function of the ankle was assessed by clinical examination and gait analysis before and at two years (2.1 to 4.0) after operation. At follow-up the ankle showed an increase in dorsiflexion at initial contact, in single stance and in the swing phase. There was an increase in dorsiflexion at initial push-off without a decrease in the range of movement of the ankle, and a significant improvement in the maximum flexor moment in the ankle in the second half of single stance. There was also a change from abnormal generation of energy in mid-stance to the normal pattern of energy absorption. Positive work during push-off was significantly increased. Lengthening of the gastrocnemius fascia by the Baumann procedure improved the function of the ankle significantly, and did not result in weakening of the triceps surae. We discuss the anatomical and mechanical merits of the procedure.

Substantial effects of epimuscular myofascial force transmission on muscular mechanics have major implications on spastic muscle and remedial surgery

“…At this point, finite element modeling offers a big advantage for studying the effects of aponeurotomy (Yucesoy et al, in press). In contrast to experimental studies in which both force transmission mechanisms are affected simultaneously and inseparably, finite element modeling allows distinguishing the effects of (1) a discontinuity within the Baumann and Koch (1989) and Saraph et al (2000). Surgical aponeurotomy described by Baumann and Koch (1989) involves at least limited fasciotomy followed by one or multiple incisions in the aponeurosis of the target muscle (in the illustrated case triceps surae muscles).…”

Muscles that influence knee flexion velocity in double support: implications for stiff-knee gait

“…Tight plantarflexors are often treated with a lengthening of the two muscles' common tendon (Olney et al, 1988;Greene, 2000), reducing the force output of both muscles. The opposing effects that these muscles have on knee flexion velocity during late stance provides an additional rationale for surgical interventions that treat these muscles separately (Delp et al, 1995;Saraph et al, 2000).…”

Classification of equinus in ambulatory children with cerebral palsy - discrimination between dynamic tightness and fixed contracture

“…The distinction between dynamic calf muscle tightness and a fixed calf muscle contracture is essential in clinical decision-making [2,6,7]. While there are non-surgical treatment options for dynamic muscle tightness [28][29][30][31][32][33], it is commonly agreed that fixed contractures can only be treated successfully by surgery [7,10,34,35].…”

“…Instrumented gait analysis has contributed to the understanding of gait dysfunction in cerebral palsy considerably. Gait analysis is also a valuable tool to document objectively gait changes after calf surgery [2,3,[8][9][10]. However, instrumented gait analysis is not yet established as a diagnostic tool to discriminate between dynamic tightness and fixed contracture of the triceps surae.…”