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Pectoralis major transfer for paralysis of elbow flexion in children
Insights
Pectoralis major transfers effectively restore elbow flexion in children with bilateral paralysis from arthrogryposis or trauma. This surgical technique yielded very good to fair subjective results and improved functional elbow movement in most patients.
Area of Science:
- Pediatric Orthopedics
- Reconstructive Surgery
- Musculoskeletal Disorders
Background:
- Bilateral paralysis of elbow flexion in children presents significant functional challenges.
- Arthrogryposis and trauma are common causes of this debilitating condition.
- Restoring elbow flexion is crucial for improving upper limb function in affected children.
Purpose of the Study:
- To evaluate the efficacy of pectoralis major transfers for restoring elbow flexion in children.
- To describe a surgical technique involving clavicular mobilization of the pectoralis major.
- To assess subjective and objective outcomes of the described surgical procedure.
Main Methods:
- Seven pediatric patients with bilateral elbow flexion paralysis underwent pectoralis major transfer.
- The surgical technique involved mobilizing the pectoralis major from the clavicle.
- The pectoralis major tendon was reattached to the biceps tendon at the elbow.
- Biceps tendon presence and mobility were confirmed in all cases.
Main Results:
- Subjective outcomes were rated as very good in six cases and fair in one.
- Functional elbow flexion against gravity and resistance was achieved in all but one patient.
- Overall functional outcomes included one very good, two good, three fair, and one poor result.
Conclusions:
- Total pectoralis major transfer, as described, provides a viable solution for restoring elbow flexion.
- The described surgical method demonstrates good to excellent functional restoration in pediatric patients.
- This technique offers a promising approach for managing elbow flexion deficits in arthrogryposis and trauma.
Abstract:
Seven pectoralis major transfers in children suffering from bilateral paralysis of elbow flexion due to arthrogryposis or to trauma are reported. A technique is described in which the muscle is mobilised from the clavicle to allow the tendon of insertion to be attached to the biceps tendon at the elbow. The biceps tendon was found to be present and could be mobilised forwards in all the arthrogrypotic elbows. Subjectively, the results were considered by patients or parents to be very good in six cases and fair in one. Elbow flexion power against gravity and against some resistance was achieved in all patients except one. The overall function was very good in one elbow, good in two, fair in three and poor in only one. The merits of the various procedures described for the restoration of elbow flexion in arthrogryposis are discussed. It is concluded that total pectoralis major transfer by the method described here has given the best results.