Proximal row carpectomy with muscle transfers for spastic paralysis

Area of Science:

• Orthopedic Surgery
• Rehabilitation Medicine
• Hand Surgery

Background:

• Spastic paralysis, often resulting from cerebral palsy, significantly impairs hand function and appearance.
• Patients require improved dexterity for self-care and daily activities.

Purpose of the Study:

• To evaluate the effectiveness of proximal row carpectomy in improving hand function and appearance in patients with spastic paralysis.
• To compare surgical techniques for optimal outcomes.

Main Methods:

• Fourteen patients with spastic paralysis underwent proximal row carpectomy.
• Surgical variations included flexor carpi ulnaris transfer or wrist extensor shortening.
• Prolonged postoperative splinting was employed.

Main Results:

• Improved wrist extension and supination were observed, particularly with subcutaneous flexor carpi ulnaris transfer.
• Grasp and pinch strength increased, though object release was diminished.
• Reduced ulnar carpal displacement occurred when the scaphoid was not removed.

Conclusions:

• Proximal row carpectomy offers functional and aesthetic benefits for spastic paralysis patients.
• Surgical technique modifications influence wrist motion and stability.
• Patient satisfaction with improved two-handed activity and appearance was high.