Simultaneous flexor carpi ulnaris transfer and selected flexor origin release for pronation flexion deformity of the forearm and hand in spastic paralysis

ABSTRACT

A procedure of simultaneous flexor carpi ulnaris [FCU] transfer and selected flexor pronation origin [FPO] release was presented for the treatment of 35 hemiplegic cerebral palsy patients with pronation flexion deformity of the forearm, h and and wrist. The patients were divided into four groups as regards the severity of deformity, surgical recommendation, potential h and function and prognosis. Pattern A included six patients with very mild deformity treated by FCU transfer and selected release of pronator teres origin with a very good functional result. Pattern B included 15 patients with mild deformity treated by FCU transfer and selected release of FPO from the medial epicondyle only with a good functional result. Pattern C included nine patients with moderate deformity treated by FCU transfer and selected release of FPO from the medial epicondyle and upper third of the forearm with a fair functional result. Pattern D included five patients with severe deformity treated as pattern C but to improve the appearance and hygiene with a poor functional result. This procedure reduced the power of wrist and finger's flexion by the release of FPO and reinforced the power of wrist extension and supination by FCU transfer. After a mean of four years follow up, the appearance of the h and and forearm was improved in all patients. No patient lost any motion and all patients gained some forearm, wrist and h and motion and there was not overcorrection of the h and or wrist deformities