Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparing the Results of the Carpi Flexor Tendon Transfer and the Classical Method of Transferring Two Tendons to Establish the Thumb and Other Fingers Extended in Patients with Radial Never Damage

Document Type : Original Article (s)

Authors
Mohammad Dehghani 1
Mohammad Javad Barati 2
Bahareh Sabzevari 2
Shaghayegh Dehghani 2
1 Associate Professor, Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Radial nerve damage is very debilitating complication. To restore the lost performance of radial nerve, classically, transferring of flexor carpi radialis and ulnaris tendons is used to restore the extension of the fingers and palmaris longus tendon transfer is used for thumb extension. The aim of this study was comparing the using of flexor carpi radialis tendon to classic method in patients with radial nerve damage.Methods: In a clinical trial study, 48 patients with radial nerve damage during 2004-2013 were selected and randomly divided in two groups. In the first group, tendon of flexor carpi radialis was used for the thumb and other fingers and in the second group, palmaris longus tendon and flexor carpi radialis tendons were used to restore the extension of the thumb and fingers, respectively. All the patients were followed 18 weeks after operation and results of surgery, including extension range of thumb and fingers and strength of hand, were compared between the two groups.Findings: Range of extension of thumb and fingers in 37.5% of first group and 16.7% of second group was above 50<sup>0 and no statistically difference between the two groups was seen (P = 0.44). Strength of thumb and fingers in 25% of first group and 12.5% of second group was equal to safe hand and no statistically difference between the two groups was seen (P = 0.68).Conclusion: According to results of this study, transferring of one flexor tendon for extension of thumb and fingers is effective as well as transferring of two tendons. As a result, intervention and invasion in transferring one tendon is lower than the transferring of two tendons.
Keywords
Tendon transfer
Radial nerve damage
Thumb extension
Fingers extension
  1. The American Academy of Family Physicians. Bites to the hand need medical attention, experts say [Online]. [cited 2015 Jan 5]; Available from: URL: http://consumer.healthday.com/general-health-information-16/bites-and-stings-news-65/bites-to-the-hand-need-medical-attention-experts-say-695245.html
  2. Armstrong MB, Adeogun O. Tendon injuries in the pediatric hand. J Craniofac Surg 2009; 20(4): 1005-10.
  3. Zareezadeh A, Dehghai M, Zarezadeh A, Nasri E. Results of flexor carpi radialis and flexor carpi ulnaris tendon transfers in chronic radial nerve palsy. J Isfahan Dent Sch 2010; 28(121): 1628-37. [In Persian].
  4. Campbell W, Canale T, Beaty JH. Campbell's operative orthopaedics. 11th ed. Philadelphia, PA: Mosby/Elsevier, 2008.
  5. Tubiana R. Problems and solutions in palliative tendon transfer surgery for radial nerve palsy. Tech Hand Up Extrem Surg 2002; 6(3): 104-13.
  6. Al-Qattan M. The "double wrist flexor" tendon transfer for radial nerve palsy. Ann Plast Surg 2013; 71(1): 34-6.
  7. Ochi K, Horiuchi Y, Matsumura T, Morita K, Kawano Y, Horiuchi K. A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy. J Hand Surg Am 2012; 37(11): 2357-61.
  8. Ratner JA, Peljovich A, Kozin SH. Update on tendon transfers for peripheral nerve injuries. J Hand Surg Am 2010; 35(8): 1371-81.
  9. Krishnan KG, Schackert G. An analysis of results after selective tendon transfers through the interosseous membrane to provide selective finger and thumb extension in chronic irreparable radial nerve lesions. J Hand Surg Am 2008; 33(2): 223-31.
  10. de Franco MJ, Lawton JN. Radial nerve injuries associated with humeral fractures. J Hand Surg Am 2006; 31(4): 655-63.
  11. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005; 87(12): 1647-52.
  12. Lowe JB, Sen SK, Mackinnon SE. Current approach to radial nerve paralysis. Plast Reconstr Surg 2002; 110(4): 1099-113.
  13. Carlan D, Pratt J, Patterson JM, Weiland AJ, Boyer MI, Gelberman RH. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg Am 2007; 32(8): 1177-82.
  14. Kato N, Birch R. Peripheral nerve palsies associated with closed fractures and dislocations. Injury 2006; 37(6): 507-12.
  15. Bishop J, Ring D. Management of radial nerve palsy associated with humeral shaft fracture: a decision analysis model. J Hand Surg Am 2009; 34(6): 991-6.
  16. Larsen LB, Barfred T. Radial nerve palsy after simple fracture of the humerus. Scand J Plast Reconstr Surg Hand Surg 2000; 34(4): 363-6.
  17. Monreal R. Steindler flexorplasty to restore elbow flexion in C5-C6-C7 brachial plexus palsy type. J Brachial Plex Peripher Nerve Inj 2007; 2: 15.
  18. Bumbasirevic M, Lesic A, Bumbasirevic V, Cobeljic G, Milosevic I, Atkinson HD. The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases. Arch Orthop Trauma Surg 2010; 130(4): 519-22.
  19. Ekholm R, Ponzer S, Tornkvist H, Adami J, Tidermark J. Primary radial nerve palsy in patients with acute humeral shaft fractures. J Orthop Trauma 2008; 22(6): 408-14.
Journal of Isfahan Medical School
Volume 33, Issue 324 - Serial Number 324
January and February 2015
Pages 203-211

  • Receive Date 14 April 2015
  • Accept Date 06 April 2022