×
Home Current Archive Editorial board
News Contact
Review paper

A new technique of flexor carpi ulnaris transfer in multilevel surgery for upper extremity deformities in spastic cerebral palsy

By
Georgy Chibirov Orcid logo ,
Georgy Chibirov
Contact Georgy Chibirov

Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan, Russia

Mairbek Pliev ,
Mairbek Pliev

Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan, Russia

Dmitry Popkov
Dmitry Popkov
Contact Dmitry Popkov

Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan, Russia

Abstract

Aim
To assess treatment outcomes of cerebral palsy (CP) patients who underwent upper limb surgical treatment including new technique of flexor carpi ulnaris (FCU) transfer.
Methods
The study included an outcome of orthopaedic surgeries in 30 upper limbs of 25 CP patients aged 10 to 24 years (mean age of 15.1 years). In addition to standard orthopaedic assessment, we used the integral scales of the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS). Functional disorders of the upper limb were also evaluated with classifications of Van Heest, House, Gshwind and Tonkin.
Results
A total of 30 surgical interventions were performed. In seven patients with hemiparesis, surgical treatment was accompanied by simultaneous intervention on the lower limb. Improvement of the functional capabilities and cosmetic appearance was noted in all cases in a follow-up over 12 months, as evidenced by an improvement in the functional class according to Van Heest classification.
Conclusion
A new technique of FCU transfer to the radius showed to be an effective method to address pronation contracture of the
forearm joints and can be used in combination with other elements of surgical intervention for elbow and thumb contractures. The FCU rerouting and transfer to distal radius is a good option in the absence of active supination. Distal release of FCU weakening flexion forces with a simultaneous procedure restoring active wrist extension provides satisfactory outcomes in the treatment of associated flexed wrist contracture.

References

1.
Stavsky M, Mor O, Mastrolia S, Greenbaum S, Than N, Erez O. Cerebral palsy -trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Front Pediatr. 2017. p. 21.
2.
Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children (Basel). 2017. p. 30.
3.
Klevberg G, Elvrum A, Zucknick M, Elkjaer S, Østensjø S, Krumlinde-Sundholm L, et al. Jahnsen R. Development of bimanual performance in young children with cerebral palsy. Dev Med Child Neurol. 2018. p. 490–7.
4.
House J, Gwathmey F, Fidler M. A dynamic approach to the thumb-in-palm deformity in cerebral palsy. J Bone Joint Surg Am. 1981. p. 216–25.
5.
Tranchida G, Heest V, A. Preferred options and evidence for upper limb surgery for spasticity in cerebral palsy, stroke, and brain injury. J Hand Surg Eur. 2020. p. 34–42.
6.
Park E, Sim E, Rha D. Effect of upper limb deformities on gross motor and upper limb functions in children with spastic cerebral palsy. Res Dev Disabil. 2011. p. 2389–97.
7.
Van Heest A. Surgical technique for thumb-in-palm deformity in cerebral palsy. J Hand Surg. 2011. p. 1526–31.
8.
Leafblad N, Heest V, A. Management of the spastic wrist and hand in cerebral palsy. J Hand Surg (Am). 2015. p. 1035–40.
9.
Seruya M, Dickey R, Fakhro A. Surgical Treatment of Pediatric Upper Limb Spasticity: The Wrist and Hand. Semin Plast Surg. 2016. p. 29–38.
10.
Gschwind C, Tonkin M. Surgery for cerebral palsy: part 1. Classification and operative procedures for pronation deformity. J Hand Surg (Br). 1992. p. 391–5.
11.
Van Heest A, Ramachandran V, Stout J, Wervey R, Garcia L. Quantitative and qualitative functional evaluation of upper extremity tendon transfers in spastic hemiplegia caused by cerebral palsy. J Pediatr Orthop. 2008. p. 679–83.
12.
Van Heest A, Bagley A, Molitor F, James M. Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy. J Bone Joint Surg (Am). 2015. p. 529–36.
13.
Fitoussi F, Diop A, Maurel N, Laasel M, Ilharreborde B, Penneçot G. Upper limb motion analysis in children with hemiplegic cerebral palsy: proximal kinematic changes after distal botulinum toxin or surgical treatments. J Child Orthop. 2011. p. 363–70.
14.
Alewijnse J, Smeulders M, Kreulen M. Short-term and long-term clinical results of the surgical correction of thumb-in-palm deformity in patients with cerebral palsy. J Pediatr Orthop. 2015. p. 825–30.
15.
Smitherman J, Davids J, Tanner S, Hardin J, Wagner L, Peace L, et al. Functional outcomes following single-event multilevel surgery of the upper extremity for children with hemiplegic cerebral palsy. J Bone Joint Surg Am. 2011. p. 655–61.
16.
Chibirov G, Dolganova T, Dolganov D, Popkov D. Analysis of the causes of pathological patterns of the kinematic locomotor profile based on the findings of computer gait analysis in children with spastic CP types. Genij Ortopedii. 2019. p. 493–500.
17.
Van Heest A, House J, Cariello C. Upper extremity surgical treatment of cerebral palsy. J Hand Surg (Am). 1999. p. 323–30.
18.
Gharbaoui I, Kania K, Cole P. Spastic paralysis of the elbow and forearm. Semin Plast Surg. 2016. p. 39–44.
19.
Simon-Martinez C, Jaspers E, Mailleux L, Desloovere K, Vanrenterghem J, Ortibus E, et al. Negative influence of motor impairments on upper limb movement patterns in children with unilateral cerebral palsy. a statistical parametric mapping study. Front Hum Neurosci. 2017. p. 482.
20.
Gschwind C. Surgical management of forearm pronation. Hand Clin. 2003. p. 649–55.
21.
Zancolli E, Zancolli E. The infantile spastic hand. Surgical indications and management. Ann Chir Main. 1994. p. 66–75.
22.
Veeger H, Kreulen M, Smeulders M. Mechanical evaluation of the pronator teres rerouting tendon transfer. J Hand Surg (Br). 2004. p. 259–64.
23.
Bunata R. Pronator teres rerouting in children with cerebral palsy. J Hand Surg (Am). 2006. p. 474–82.
24.
Tranchida G, Heest V, A. Outcomes After Surgical Treatment of Spastic Upper Extremity Conditions. Hand Clin. 2018. p. 583–91.
25.
Green W, Banks H. Flexor carpi ulnaris transplant and its use in cerebral palsy. J Bone Joint Surg (Am). 1962. p. 1343–430.
26.
Patterson J, Wang A, Hutchinson D. Late deformities following the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis in children with cerebral palsy. J Hand Surg (Am). 2010. p. 1774–8.
27.
Čobeljić G, Rajković S, Bajin Z, Lešić A, Bumbaširević M, Aleksić M, et al. The results of surgical treatment for pronation deformities of the forearm in cerebral palsy after a mean follow-up of 17.5 years. J Orthop Surg Res. 2015. p. 106.
28.
Bisneto Ede N, Rizzi N, Setani E, Casagrande L, Fonseca J, Fortes G. Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor carpi ulnaris transfer. Acta Ortop Bras. 2015. p. 150–3.
29.
Hoffer M. The use of the pathokinesiology laboratory to select muscles for tendon transfers in the cerebral palsy hand. Clin Orthop Relat Res. 1993. p. 135–8.
30.
Chibirov G, Leonchuk S, Ezhova K, Gubina E, Pliev M, Lascombes P, et al. Operative treatment of orthopedic complications in upper limb in children and adults with cerebral palsy. Genij Ortopedii. 2018. p. 312–20.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.