REACTIVATION OF ACTIVE ELBOW EXTENSION AND CONSTRUCTION OF THE KEY GRIP IN ONE OPERATION IN A HIGH TETRAPLEGIA PATIENT

Abstract

Purpose: Reactivation of upper limb function in high-tetraplegia patients requires two successive procedures: restoration of elbow extension, then construction of the key grip. Performing both procedures during the same operative time can reduce the operative time. We compared this combined technique with the classical programme, particular for patients requiring transfer of the brachioradialis to construct the key grip.

Material and methods: The study series included 16 upper limbs in 15 tetraplegic patients. Two distinct operative programmes were used. Group A (nine limbs): transfer of the posterior deltoid to the triceps and active key grip by transfer of the brachioradialis on the flexor pollicis longus. According to the Giens classification there were three group 2, five group 3 and one group 4. Group B (seven limbs): transfer of the biceps on the triceps and passive tenodesis key grip. The Giens classification was five group 2 and two group 3. Five of these limbs exhibited supination attitude of the forearm that was treated initially with isolated osteotomy of the radius. Mean follow-up was ten months. A control group underwent the same surgical programmes but with two distinct operative times.

Results: Mean hospital stay was shortened compared with the control group 4.1±0.8 months versus 10±1.0 months). Elbow extension force according to the BMRC scale was 3.8±0.6 in Group A versus 3.5 for the control group and 3.2±0.5 for Group B compared with 2.8 for the control group. Mean active key grip force was 1.8±0.9 kg for Group A versus 1.9 for controls and 0.9±0.6 kg for the passive key grips in Group B versus 0.9 for controls. Functional independence improved postoperatively, the QIF improved from 40.0±18.0 to 55.2±17.0.

Discussion: This work demonstrated that a single operation shortens hospital stay without affecting the final outcome and that the brachioradial can be transferred on the flexor pollicis longus for reactivation of elbow extension. In our experience, only 46% of the tetraplegic patients starting a functional surgery programme benefit from reactivation of the elbow and hand. Procedures performed during a single operation allow a more systematic approach.