Tendon Transfers for Defective Long Extensors of the Wrist and Fingers

Thomsen, Mogens; Rasmussen, Knud Bang

doi:10.3109/02844316909036698

Cited by 22 publications

(5 citation statements)

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“…In group 3 patients of the present study, the FDS tendons were passed subcutaneously, the main reason being the fear of surgeon of “aggressiveness” of the operation and median nerve injury, which has been the concern of others too 13. We could not find a written reason for choosing the interosseous route for transfer of tendons, except probably for a better line of traction and again we do not see any clear proof that a tendon passed subcutaneously would not act as good as the one passed from the interosseous space, given the reverse is not true 2.…”

Section: Discussionmentioning

confidence: 92%

Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods

Moussavi

Saied

Karbalaeikhani

2011

IJOO

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Background:Tendon transfer for radial nerve paralysis has a 100 years history and any set of tendons that can be considered to be useful has been utilized for the purpose. The pronator tress is used for restoration of wrist dorsiflexion, while the flexor carpi radialis, flexor carpiulnaris, and flexor digitorum superficialis are variably used in each for fingers and thumb movements. The present study was a retrospective analysis, designed to compare three methods of tendon transfer for radial nerve palsy.Materials and Methods:41 patients with irreversible radial nerve paralysis, who had underwent three different types of tendon transfers (using different tendons for transfer) between March 2005 and September 2009, included in the study. The pronator teres was transferred for wrist extention. Flexor carpi ulnaris (group 1, n=18), flexor carpi radialis (group 2, n=10) and flexor digitorum superficialis (group 3, n=13) was used to achieve finger extention. Palmaris longus was used to achieve thumb extention and abduction. At the final examination, related ranges of motions were recorded and the patients were asked about their overall satisfaction with the operation, their ability, and time of return to their previous jobs, and in addition, disabilities of the arm, shoulder and hand (DASH) Score was measured and recorded for each patient.Results:The difference between the groups with regard to DASH score, ability, and time of return to job, satisfaction with the operation, and range of motions was not statistically significant (P>0.05). All of the patients had experienced functional improvement and overall satisfaction rate was 95%. No complication directly attributable to the operation was noted, except for proximal interphalangeal joint flexion contracture in three patents.Conclusion:The tendon transfer for irreversible radial nerve palsy is very successful and probably the success is not related to type of tendon used for transfer.

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Section: Discussionmentioning

confidence: 92%

Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods

Moussavi

Saied

Karbalaeikhani

2011

IJOO

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“…(32) Thomsen and Rasmussen compare the results of FCU (13 patients) and FDS tendon transfer (10 patients) and present similar results. The total score achieved by FCU tendon transfer is 86% (29). The total FDS tendon transfer result is 85%.…”

Section: Discussionmentioning

confidence: 93%

Assessment of the Forearm Tendon Transfer with Irreparable Radial Nerve Injuries Caused by War Projectiles

Karabeg¹

2019

Med Arch

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Introduction: Injuries to the radial nerve can occur at any point along its anatomical route, and the etiology quite varies. A particular entity are war injuries of the extremities, which have high morbidity but low mortality. After irreparable radial nerve injury, the only treatment is tendon transfer (if we neglect arthrodesis) with over then 40 methods. Four tendon transfers are considered as better than the other and two of them are the subject of our article flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU). Aim: To evaluate the ultimate functional results of forearm tendon transfers for irreparable radial nerve damage caused by war injuries and indicate the better operative treatment choice in accordance with the evaluation schemes. Methods: This retrospective research included 40 patients with isolated irreparable radial nerve damage. Patients were operated from 1993 to 1996. The follow-up period is from 3.5 to 11.5 years (until 2007). Twenty patients were operated using FCR tendon transfer method and twenty patients were operated using FCU tendon transfer method. The surgery was performed at the Clinic for Reconstructive and Plastic Surgery, Clinical Center University of Sarajevo. Three score evaluation schemes were used: Zachary, Neumann Pertecke and Tajima scheme, along with subjective evaluation of treatment. Results: Measured by the Zachary Evaluation Scheme, the overall score in patients undergoing FCR tendon transfer is 92.25%. In patients undergoing FCU tendon transfer, the total score was 82.20%. The total result of all 40 operated patients was 87.25%. The Zachary evaluation scheme showed a significant difference between FCR and FCU results by tendon transfer (p <0.05) in favor of the FCR tendon transfer. Tajima scheme proved a statistically significant difference between the two tendon transfers (p = 0.024), also in favor of FCR tendon transfers. Conclusion: Forearm tendon transfer is a relevant method to compensate for the loss of function of the wrist, fingers and thumb extensions as a result of irreparable damage to the radial nerve. FCR tendon transfer provides better functional results than FCU tendon transfer in irreparable radial nerve damage. The time elapsed from the injury to the performed surgery of the tendon transfer has no effect on the final functional result. There is no surgical tendon transfer procedure that can be recommended as a standard for any patient. Practically, the surgeon must tailor the surgery to the patient's needs. It is necessary to develop a unique and generally accepted evaluation scheme for the results of tendon transfers that will enable comparisons of results achieved. Both methods can be used for irreparable damage of radial nerve due to any etiology.

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“…3). Viele Patienten können damit nach wenigen Wochen wieder in ihre alte berufliche Tätigkeit zurückkehren [10,18,25]. …”

Section: Nachbehandlung/prognoseunclassified

“…Diese enorme Plastizität des Gehirns wird offensichtlich u.a. auch durch die Mikrobewegungen im Gips getriggert[16,25,26].Insbesondere bei Patienten jenseits des 45. Lebensjahres, aber auch bei jüngeren, ist nach einer Nervenverletzung-auch bei optimaler Versorgung-nicht regelhaft mit einer Restitutio ad integrum zu rechnen[1,6,7,12,16].…”

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Improved outcome of nerve injuries in the upper extremity

et al. 2006

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Nerve injuries in the upper extremity can result in severe disability. In the past three decades, progress in microsurgical techniques and instruments have resulted in improved outcomes for nerve injuries. If the prognosis is reasonably good, nerve repair is usually preferred over tendon or flap transfer procedures. However, lesions of peripheral stem nerves such as high radial nerve palsy may still yield unsatisfactory results, despite technically well-executed nerve repair. Prognosis further depends on the age of the patient; the regenerative process is delayed in older patients. Further criteria for the indication for tendon transfers are the personal and professional profiles of individual patients. Tendon or flap transfers to restore sensation can be performed at any time post trauma when it becomes clear that long-term rehabilitation is required. These procedures abbreviate the interval during which hand function is severely impaired, so that patients have alternatives to persistent nerve palsy with the need of permanent external splints, and long and costly rehabilitation can be shortened. Sophisticated techniques allow minimal donor site morbidity and leave options open in case function of the reconstructed nerve returns. The present article gives an overview of the most common procedures to restore hand function and sensation in the most important digits and provides help for decision making.

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Tendon Transfers for Defective Long Extensors of the Wrist and Fingers

Cited by 22 publications

References 1 publication

Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods

Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods

Assessment of the Forearm Tendon Transfer with Irreparable Radial Nerve Injuries Caused by War Projectiles

Improved outcome of nerve injuries in the upper extremity

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