Wrist arthrodesis after double free-muscle transfer in traumatic total brachial plexus palsy

Double free-muscle transfer is a technique used to treat patients with total brachial plexus palsy to restore hand prehension. It involves the reconstruction of shoulder stability, the transfer of 2 functioning gracilis muscles, and other complementary procedures to optimize the function of the transferred muscles. Wrist arthrodesis is one of these complementary procedures. Our technique of wrist arthrodesis in these patients is different from the standard technique. In this article, we describe our technique and experience of wrist arthrodesis in patients with complete brachial plexus palsy treated with double free-muscle transfer technique. In our procedure, the plate is fixed from the second metacarpal--and not the third as is the usual practice--to the radius to avoid friction with the extensor digitorum communis tendons. A very small bone graft, prepared from the removed Lister tubercle, is needed because of the very thin articular cartilage in these patients. A short arm splint is used for only 1 week postoperatively to avoid finger stiffness. There were no major complications such as pseudoarthrosis or metal failure in our patients because the affected limb is subjected only to mild stresses.