Post on 14-Apr-2018
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
Dept. of Orthopaedics & Traumatology Faculty of MedicineAirlangga University Dr. Soetomo General Hospital
SURABAYA
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
Radial nerve palsy associated with fractures of the shaftofthe humerus is the most common nerve lesion
complicating fracturesof long bone(Crenshaw AH. 1992)(Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD,1996)
Tendon transfers have been used for radial nerve palsyfor morethan one century (Tubiana, 1991, 2002) when hopeof spontaneousor surgical recovery appears to beunlikely.
Nerve graftingmay restore sensation and motorfunction but, even when thisprocedure is possible, theresult is not always good enoughto give complete
extension of the wrist and digits(Ring et al., 2004)
http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/5027/30/2019 Standart FCU Transfer
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The main problem for the surgeon is thechoice of tendons to transfer
In a high radial nerve palsy, three tendons willusuallybe required to restore each one ofthree functions:
extensionof the wrist,
extension of the fingers and extensionabductionof the thumb
(Scuderi, 1949; Tubiana, 2002).
http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/502http://jhs.sagepub.com/cgi/content/full/31/5/5027/30/2019 Standart FCU Transfer
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We observed 5 patients whom have been operated
between 2006 - 2007 at Dr.Soetomo Hospital.
4 patients underwent a tendon transfer for radialnerve injury after failure to recover following nerverepair and 1 because high demanding
Patients with radial nerve dysfunctionafter brachialplexus injury were not included
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In high radial nerve palsy (n = 5), thetendon of pronator teres(PT) was
always transferred to achieve wristextension
The
transferred tendon was alwaysattached to the extensor carpiradialisbrevis (ECRB) distally
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Extension of the fingers was restored
with the flexor carpi ulnaris
(FCU).
The transferred tendon was suturedtothe extensor digitorum communis(EDC)
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The goal of the transfer to the thumb isas much to allow openingof the firstweb space as to provide extension ofthe thumb.
(Dr Mickal Ropars, Orthopaedic and Reconstructive Surgery Unit, Hospital SudUniversity, France)
Thumb Extension restore by PL torerouted EPL.
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patients were immobilisedin extension in avolar splintfor four weeks.
Passive motion was thenstarted.Active motion wasallowed from six weeks
after surgery
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DF PF MP Ext FT-MPC ABD IP Ext
Excellent >50 >30 >170 0 >40 >180
Good 25 to 50 10 to 30 135 to 170 0 to 1n 30 to 40 165 to 180
Fair
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Sex,Age,handed: Male, 46 years
old,Right
Injured hand
Right
Cause CF humerus [R}
Previoustreatment
ORIF [Plating] 6 years
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Wrist extension
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MCPExtension/flexion
Thumb Extension
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Sex,Age,handed:
Male, 43 yearsold,Right
Injured hand
Right
Cause
Stab lateral andpost arm
Previoustreatment
Radial nerverepaire
EMG: no function below triceps (4 months)
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Wrist extension/Flexion
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MCP extensionThumb extension
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Sex,Age,handed:
Female, 24 years old,Right
Injured hand
Right
Cause
CF humerus [R]
Previous treatmentORIF [Plating] and radialnerve repaire
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Wrist extension/Flexion
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MCP extension
Thumb extension
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Sex,Age,handed:
Male, 60 yearsold,Right
Injured handRight
Cause
CF humerus [R]
Previous treatment
ORIF [Plating]5,5 years
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Wrist extension/Flexion
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MCP extension
Thumb Extension
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Sex,Age,handed:
Male, 38 yearsold,Right
Injured handleft
Cause
OF humerus[L]
Fell down from a train
Previous treatmentORIF [Plating]
5 months
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
Wrist extension
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Thumb Extension
MCP extension
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Results
DF PF MP Ext FT-MPC ABD IP Ext
Case 1 55 30 180 0 40 180 excellent
Case 2 80 30 175 0 45 180 excellent
Case 3 85 20 180 0 40 185 excellent
Case 4 85 50 180 0 45 180 excellent
Case 5 75 50 180 0 45 180 excellent
Mean 76 36 179 0 43 181 excellent
Results wrist finger thumb Results
The functional results were assessed using the method describedbyRobert G.Chuinard that modified Zachary methode
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
DISCUSSION
In respect of the range of motion of the wrist,we recordeda wider range of wrist extensionthan flexion abilities in ourseries
This asymmetry between flexion range andextensionrange may either be explained by theway the tension of thetransfer is adjustedduring surgery or by the tendon used forthefinger extension transfer
Those differences have no functional importancebecause a rangeof motion of 20/20 isadequate for normal function(Kruft, 1997).
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
During testing of power of gripping,1 patient (case 3) had radialdeviation 20 degrees compensation
during this testing.
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
We use standard (FCU) set of transfer andhad excellent results
We will use others technique (Tsugeprocedure, boyes) for the individualpatient rather than to try to adapt allpatients to single procedure.
whatever the transfers used, they mostly give
efficient results in terms of mobility andsubjective satisfaction
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W A K E F O R E S T U N I V E R S I T Y S C H O O L O F M E D I C I N E
Candidate for tendon transfer
1 year post transfer
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