Which of the following is a bone procedure used in CP management?

• A. Distal femoral extension osteotomy
• B. Tendon release/lengthening
• C. Botulinum toxin injections
• D. Capsulotomy

Answer: (A)

Bone procedures alter the structure or alignment of bone to improve limb mechanics, which is necessary when the knee deformity from cerebral palsy limits stance and gait. A distal femoral extension osteotomy is a bone procedure that surgically cuts the distal femur and adds a wedge to shift the distal segment into more extension. This directly changes knee alignment, reduces knee flexion contracture, and can improve standing and walking in ambulatory CP patients with crouch gait. In contrast, tendon release/lengthening and botulinum toxin injections are soft tissue approaches that target muscles and tendons to decrease tightness or spasticity, not bone alignment. Capsulotomy releases the joint capsule but likewise does not modify bone structure. Hence, the bone procedure among these options is distal femoral extension osteotomy.