Transfer of brachialis muscle to triceps for restoration of elbow extension ın patients wıth obstetric palsy sequelae
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Abstract Objective: Elbow extension deficit following brachial plexus injuries can sometimes be overlooked. Elbow flexion deficit is more prominent in the early stages of obstetric paralysis and is used as an indication for early nerve surgery. However, in the future extension deficits may become more numerous. Residual disabilities following obstetric paralyses can be dynamically addressed by tendon transfers. In patients with obstetric paralysis, canonical donor muscles such as the deltoid or biceps may be insufficient for restoration of elbow extension. The brachialis muscle, because of its deep and secluded position, may be considered as one of the more recent options for selection as a donor in these patient groups. In this study, the efficiency of brachialis to triceps transfer both in elbow extension and in shoulder abduction was assessed. Materials and Methods: Seven obstetrical palsy patients with varying degrees of sequelae around the shoulder and elbow underwent a brachialis to triceps transfer procedure. All patients had previously undergone a modified Hoffer procedure. Ranges of motion in shoulder and elbow joints were recorded before and after the transfer. A minimum of M3+ in elbow flexion was set as a prerequisite for the transfer. Results: The elbow extension was improved from a median of -70° (interquertile range, IQR: 20º) to a median of -10° (IQR: 35º) in the follow-up (p<0.05). Shoulder abduction was improved from a median of 140° (IQR: 5º) to a median of 170° (IQR: 15º) (p<0.05). Elbow flexion power was found to be diminished from median M4 (Q1: M3+, Q3: M5) to M3 (Q1: M3, Q3: M3+) (p<0.05). Conclusions: Brachialis to triceps transfer was found to be a suitable alternative in palliative surgery of obstetric palsy patients in terms of elbow extension. Loss of elbow flexion power was within acceptable range.
Sourceİstanbul Tıp Fakültesi Dergisi
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