The Steindler method in the treatment of paralytic elbow flexion

Based on an average follow-up of 8.6 years, the authors analyse the functional results obtained in 16 patients submitted to Steindler flexoroplasty of the elbow between 1975 and 1986. The absence of active flexion of the elbow produces a severe deficit in the upper limb even when there is good function of the shoulder and hand. Since 1921, the year in which Steindler published a report on his surgical method, numerous surgical methods have been described for the treatment of paralytic elbow. Clark (1946), Merle d'Aubigné et al. (1956), Brook and Sendon (1959) propose transposing pectoralis major by suturing it to the tendon of the biceps muscle. Le Coeur (1953) instead isolates pectoralis minor and then transposes it on the biceps tendon. Bunnel (1951) describes two methods: the first consists in isolating the sternocleidomastoid by lengthening it with the fascia lata and inserting it into the tendon of the biceps, the second proposes anteriorly transposing the distal triceps tendon. Hovnanian (1956) and Zancolli and Mitré (1973) transpose the latissimus dorsi by inserting it distally on the distal biceps tendon, while Axer et al. (1973) transpose part of the same muscle. It is the purpose of this study to report the experience obtained using the Steindler method in 22 patients affected with paralysis of the flexor muscles of the elbow.