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Long-term follow-up of the flexor carpi ulnaris transfer in spastic hemiplegic children
1Children's Hospital of Wisconsin, Milwaukee.
Insights
Flexor carpi ulnaris transfer to radial wrist extensors improved wrist dorsiflexion in cerebral palsy patients. However, this surgery often resulted in reduced active palmar flexion, necessitating careful patient selection.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Neurology
Background:
- Cerebral palsy (CP) frequently involves wrist spasticity and dysfunction.
- Restoring functional wrist extension is crucial for improving upper limb use in CP patients.
Purpose of the Study:
- To evaluate the effectiveness of flexor carpi ulnaris (FCU) to radial wrist extensor transfer in children with cerebral palsy.
- To assess functional outcomes, including range of motion and patient satisfaction, following this surgical procedure.
Main Methods:
- A retrospective study of 25 pediatric patients with cerebral palsy who underwent FCU to radial wrist extensor transfer.
- Surgical intervention involved transferring the FCU tendon to augment radial wrist extensors.
- Patient outcomes were assessed using a modified Green's evaluation system and objective measurements of wrist motion.
Main Results:
- The mean active wrist dorsiflexion improved significantly post-surgery (44.2 degrees).
- Mean active palmar flexion decreased postoperatively (19.0 degrees).
- Six excellent, nine good, five fair, and five poor results were reported based on Green's criteria; two patients needed revision surgery.
Conclusions:
- FCU to radial wrist extensor transfer is effective for enhancing wrist dorsiflexion in cerebral palsy.
- A significant loss of active palmar flexion is a common postoperative complication.
- Patients with good digital extension and passive wrist extension above neutral are better candidates for this procedure.
Abstract:
A retrospective study was performed on 25 patients with cerebral palsy who underwent transfer of the flexor carpi ulnaris to the radial wrist extendors. The mean age at the time of surgery was 8 years 1 month. The mean follow-up was 8 years 7 months. At follow-up, the mean active wrist dorsiflexion was 44.2 degrees, palmar flexion was 19.0 degrees, supination was 40.2 degrees, and pronation was 53.4 degrees. According to a modification of Green's evaluation system, there were six excellent, nine good, five fair, and five poor results. Two patients required further surgery to correct a supination, dorsiflexion contracture. We found the transfer to be quite effective in improving wrist dorsiflexion, although there was often a significant loss of active palmar flexion postoperatively. The patient therefore should have good digital extension (with the wrist extended passively above neutral) to be considered for the transfer.