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The Green Transfer-Long-Term Results.

Douglas T Hutchinson1, Michelle A James2, Wendy A Tomhave3

  • 1University of Utah Orthopaedic Center, Salt Lake City, UT.

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|December 3, 2023
PubMed
Summary

The Green transfer surgery for hemiplegia shows variable long-term wrist positioning but favorable patient-reported outcomes. This tendon transfer can improve function and appearance for affected individuals.

Keywords:
FCU to ECRBGreen transferhemiplegiawrist flexion contracture

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Area of Science:

  • Orthopedic surgery
  • Pediatric rehabilitation
  • Cerebral palsy research

Background:

  • Hemiplegia, often caused by cerebral palsy, frequently affects wrist function.
  • Tendon transfer surgery, like the Green transfer, is used to improve hand and wrist function in these patients.
  • Long-term outcomes of the Green transfer (flexor carpi ulnaris to extensor carpi radialis brevis) require further investigation.

Purpose of the Study:

  • To evaluate the long-term results of the Green transfer procedure.
  • To assess patient-reported outcomes, including wrist position and range of motion.
  • To determine the effectiveness of this tendon transfer in hemiplegic patients after an average of 8 years post-surgery.

Main Methods:

  • A cohort of 13 patients from a prior prospective study underwent re-examination.
  • Wrist range of motion and postoperative wrist alignment were measured.
  • Patient-reported outcomes were assessed using validated instruments like the Pediatric Orthopedic Data Collection Instrument and the Pediatric Quality of Life questionnaire, alongside visual analog scales for appearance.

Main Results:

  • At long-term follow-up (average 8 years), 7 of 13 patients achieved a near-neutral wrist position with functional flexion and extension.
  • Wrist range of motion showed mixed results: improvement in 4, decrease in 4, and no change in 5 patients.
  • Despite variable positional outcomes, statistically significant improvements were observed in patient-reported functional scores and perceived appearance.

Conclusions:

  • The Green transfer (flexor carpi ulnaris to extensor carpi radialis brevis) demonstrates variable long-term wrist positioning in hemiplegic patients.
  • However, the procedure yields favorable patient-reported outcomes regarding function and appearance.
  • This tendon transfer is a viable option for improving quality of life in hemiplegic individuals.