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Journal of Bone and Joint Surgery, 1943;25:745-767.
© 1943 by The Journal of Bone and Joint Surgery, Inc

SPASTIC PARALYSIS AND ALLIED DISORDERS

H. R. McCarroll M.D.1 and John R. Schwartzmann M.D.1

1 Shriners' Hospital for Crippled Children and the Department of Surgery, Washington University, St. Louis

A series of 1720 consecutive cases of spastic paralysis and allied disorders are herein analyzed from the standpoint of classification, characteristics of each class, and etiology. The 1217 cases of lesions of the pyramidal tract are discussed in detail from the standpoint of the extremities involved, associated conditions, requirements or prerequisites for surgical correction of the deformities, and reasons for non-intervention in those cases rejected for surgery. The various deformities encountered in both upper and lower extremities are then discussed with the various operations which have been used, together with the results obtained. An attempt is made to establish some rationale for the selection of the most desirable operation in each type of deformity.

The total number of operations on the upper extremities was 115 with only sixteen good results. Surgical treatment on the whole is unsatisfactory, with improvement primarily cosmetic, not functional. Attempts at correction of deformities in the upper extremity are justified for:

1. Pronation of the forearm,

2. Flexion of the wrist.

The total number of operations on the lower extremities was 1063 with 677 good results. Surgical treatment on the whole is satisfactory, and should be attempted for:

1. Adduction of the thighs,

2. Internal rotation of the thighs,

3. Flexion deformity of the knees,

4. Spasm or contracture of the heel cord,

5. Other fixed foot deformities.


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