Standart FCU Transfer

7/30/2019 Standart FCU Transfer

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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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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)
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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).
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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)



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.



patients were immobilisedin extension in avolar splintfor four weeks.

Passive motion was thenstarted.Active motion wasallowed from six weeks

after surgery



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



Sex,Age,handed: Male, 46 years

old,Right

Injured hand

Right

Cause CF humerus [R}

Previoustreatment

ORIF [Plating] 6 years



Wrist extension



MCPExtension/flexion

Thumb Extension



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)



Wrist extension/Flexion



MCP extensionThumb extension



Sex,Age,handed:

Female, 24 years old,Right

Injured hand

Right

Cause

CF humerus [R]

Previous treatmentORIF [Plating] and radialnerve repaire



MCP extension

Thumb extension



Sex,Age,handed:


Injured handRight

Cause

CF humerus [R]

Previous treatment

ORIF [Plating]5,5 years



MCP extension

Thumb Extension



Sex,Age,handed:


Injured handleft

Cause

OF humerus[L]

Fell down from a train

Previous treatmentORIF [Plating]

5 months


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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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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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During testing of power of gripping,1 patient (case 3) had radialdeviation 20 degrees compensation

during this testing.


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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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Candidate for tendon transfer

1 year post transfer


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Standart FCU Transfer

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