gms | German Medical Science

Objectives/Interrogation: Evaluate functional results, after a surgical reconstruction of elbow extension with deltoid to triceps transfer.

Methods: Prospective cohort study of 10 tetraplegic patients (11 elbows). 6 men and 4 women, between 17 and 29 years of age, 1 patient from group 1 of ICSHT, 8 from group 2 and 1 from group 3. The patients were evaluated by a multidisciplinary team. To restore the active elbow extension we used the posterior deltoid to triceps transfer whit anterior tibial tendon graft. Elbow extension strength was measured according to BMRC 1-5. Performance and satisfaction was assessed by the Canadian Occupational Personal Measure (COPM), which rates patient individual goals, and activities of daily living with the WeeFIM scale. Follow up was performed at 6 and 12 months postoperatively. Surgeries were carried out between May 2013 and July 2017. Reconstruction of elbow extension was done with posterior deltoid to triceps transfer using anterior tibialis tendon graft. Patients were discharged home the day after surgery, and entered a rehabilitation protocol that included immobilization in elbow extension and shoulder abduction for 3 weeks, and then progressive elbow flexion was encouraged but protected with an articulated elbow brace. After 3 month free elbow motion was allowed.

The statistical analysis was performed using SPSS v17.0 software, summary measures were calculated and the comparison was made through nonparametric Friedman and Wilcoxon statistics, all with p <0.05.

Results and Conclusions: All patients improve elbow extension strength from a median of M2 strength to M3 at 6 months and M4 at 12 months (p 0,0004). There was a significant improvement in each individual goals measured by the COMP from a median of 2 points of performance at preoperative assessment to 4 points at 6 months and 7 points at 12 months after surgery. Satisfaction improved from a median of 2 points to 5 points at 6 months and 8 points at 12 months after surgery (p 0.033). WeeFIM scale improved in many activities such as self-care (p 0.034) bathing (p 0.033), dressing (p 0,02), self-catheterization (p 0.042), and use of wheelchair (p 0.08). There was one early postoperative complication consisting of pain that required hospitalization in 3 patients.

Restoration of elbow extension with deltoid to triceps transfer in patients with tetraplegia results in a significant improvement in their own perception of gain in activities that are meaningful in their daily living.