Improved kinematics of unrestrained arm raising in C5-C6 tetraplegic subjects after deltoid-to-triceps transfer.

STUDY DESIGN: Prospective comparative study. OBJECTIVE: To determine whether control of upper limb joint synergy during unrestrained arm raising involving shoulder and elbow flexion is modified by deltoid-to-triceps transfer. SETTING: Rehabilitation unit for spinal cord injury patients, France. METHODS: Five C6 subjects with C5-C6 tetraplegia sustained posterior deltoid-to-triceps transfer and were compared to a control group of 11 subjects. Kinematics of shoulder and elbow joints before, 6 month and 1 year after surgery, during straight-arm raising (SAR) in the plane of the scapula and hand-to-nape-of-neck movements (HNNMs) were explored. Motion was recorded with a six-camera Vicon motion analysis system and the data used to assess the coupling of elbow and shoulder flexion velocities (EFVs and SFVs) and extension velocities. RESULTS: All subjects were initially assessed at 6.9 months (mean) postsurgery. Three of the upper limbs were assessed a second time (mean 17.9 months). The first assessment showed an increase in shoulder flexion amplitudes in tetraplegic subjects with presurgery shoulder flexion deficits. Peak SFVs and EFVs and extension velocities were slightly modified at the first postsurgery assessment and dramatically improved at the second assessment during both SAR and HNNM. Despite these increased velocities, joint coordination was only partially restored. CONCLUSION: A restored elbow active extension improves the speed of elbow flexion. The additional improvement of shoulder motion emphasises the relation between joints in the control of arm movement.

[Dangers of ischiectomy in ulcers in the paraplegic patient. Review of 236 records]. / Les dangers de l'ischiectomie pour escarre chez le paraplégique. Revue de 236 dossiers.

Two hundred and thirty-six paraplegics were operated on for unilateral or bilateral ischial ulceration between 1956 and 1981. A study was made of the long-term results, of the development of recurrences or bilateral involvement in unilateral lesions, of secondary complications and of their treatment and consequences. A distinction was made between procedures involving removal of the ischium and those with preservation of bone. The results, with a follow-up of one to 28 years were less satisfactory after extensive bony resection. Recurrence reached 50 per cent and a contralateral ulcer developed in up to 50 per cent. In contrast, when the ischium was preserved, these figures were respectively 20 per cent and 10 per cent. Complications such as the appearance of other pressure sores, or of perineal or urethral lesions occurred in 50 per cent of cases in which both ischia were resected but did not reach 15 per cent if the ischia were preserved. The analysis of these complications, their etiology and their outcome, with eleven deaths and two disarticulated hips implies the need to treat these ulcerations without removing the ischium. Infection and osteomyelitis can be healed without sacrifice of bone with at most one or two procedures preceding a plastic procedure. Myocutaneous flaps can be used to fill the lesions and to cover the bone with the help of proximal mobilisation of the hamstring muscles.