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Modified Steindler procedure for elbow flexion restoration

G A Brunelli1, A Vigasio, G R Brunelli

  • 1Department of Orthopaedics, Brescia University Medical School, Italy.

The Journal of Hand Surgery
|September 1, 1995
PubMed
Summary
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Modified Steindler procedures effectively restore elbow flexion in patients with brachial plexus injuries. This surgical technique avoids unintended finger flexion and pronation, yielding significant functional improvements.

Area of Science:

  • Orthopedic Surgery
  • Reconstructive Surgery
  • Pediatric Orthopedics

Background:

  • The Steindler procedure is a surgical technique to restore elbow flexion.
  • A common drawback is the need for patients to make a fist to achieve elbow flexion (Steindler's effect).
  • Modifications aim to overcome this limitation and improve functional outcomes.

Purpose of the Study:

  • To review the results of modified Steindler procedures for elbow flexion over 20 years.
  • To evaluate the effectiveness of modifications designed to prevent the Steindler's effect.
  • To determine the indications for this procedure, particularly in brachial plexus reconstructive surgery.

Main Methods:

  • Retrospective review of 32 modified Steindler procedures.
  • Transfer of flexor carpi ulnaris, flexor carpi radialis, and palmaris longus with a bone fragment to the anterior humerus.

Related Experiment Videos

  • Careful separation of transferred muscles from flexor digitorum superficialis to avoid finger flexion and pronation.

    • Main Results:

    • Modified Steindler procedures were assessed based on elbow flexion against resistance.
    • A 'very good' rating was achieved for flexion over 120 degrees when lifting 3 kg.
    • Out of 32 procedures, 18 were rated 'very good', 8 'good', 4 'fair', and 2 'poor'.

    Conclusions:

    • Modified Steindler procedures offer a viable solution for restoring elbow flexion.
    • The technique is particularly indicated for upper brachial plexus lesions (C5-C6).
    • Results suggest good to very good functional outcomes in a majority of patients.