Extensor Carpi Ulnaris to Extensor Carpi Radialis Brevis Tendon Transfer in Pediatric Patients with Cerebral Palsy

Spastic wrist flexion deformity is a common manifestation of cerebral palsy (CP) that not only impairs grasp but also serves as a visible marker of neurologic impairment. The flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) transfer is a well-established technique that both reduces wrist flexion force and augments extension, though it carries a risk of postoperative hyperextension deformity. This study describes the surgical technique and outcomes of an alternative procedure - extensor carpi ulnaris (ECU) to ECRB tendon transfer - for the correction of spastic wrist flexion deformity.

A retrospective study was performed to analyze outcomes pediatric CP patients who underwent extensor carpi ulnaris (ECU) to extensor carpi radialis brevis (ECRB) tendon transfer to improve wrist extension and grip strength. Primary assessment included wrist position and range of motion, active grasp, and subjective improvement in grasp after surgery. Secondary outcomes included the need for an additional procedure to further correct wrist position after tendon transfer.

Twenty-six wrists in 24 patients underwent ECU to ECRB transfer. Postoperatively, 22 wrists (85%) achieved extension beyond neutral at an average of 28 degrees. Improved grasp was reported by 21 patients (81%). Five underwent revision for recurrent wrist flexion deformity and one for fixed extension.

ECU to ECRB tendon transfer is a safe and effective technique to reliably improve wrist posture and grasp in patients with spastic CP.Level of Evidence: III Treatment.