Given that the GMFCS is a grading system and not an outcome measure, it is the major prognostic information that must be considered in all children with CP.
Gait correction surgery is an option for many children with CP at GMFCS levels I to III but with different clinical goals at each level. SEMLS will be discussed primarily in the GMFCS level II section. Preventive hip surgery will be discussed in the GMFCS level III section, reconstructive hip surgery in the GMFCS level IV section, and salvage surgery in the GMFCS level V section.
Between 6th and 12th birthdays: Children walk in most settings and climb stairs holding onto a railing. They may experience difficulty walking long distances and balancing on uneven terrain.
Children have only minimal ability to perform gross motor skills such as running and jumping .
Between 12th and 18th birthdays: Youth walk in most settings, but environmental factors and personal choice influence mobility choices. At school or work, they may require a handheld mobility device for safety and climb stairs holding onto a railing. Outdoors and in the community, youth may use wheeled mobility when traveling long distances .
Risk of hip displacement :
(MP greater than 30%): 15%
Most children at GMFCS level II have either a type IV hemiplegia or a mild spastic diplegia.
Single event multiple level surgery
Hip: Varus derotation osteotomy
Knee: semit transfer + 8 plate
Ankle: ETT derotation
Foot: calcaneous lengthening or subtalar fusion