gms | German Medical Science

Objectives/Interrogation: Radial deviation deformity after the tendon transfer for restoration of wrist and digital extension is frequently talked about. It is a great concern while performing tendon transfer for patients with posterior interosseousnerve palsy because these patients have a functioning extensor carpi radialis longus which is more of a radial deviator and secondary extensor in absence of parlayzed extensor carpi radialis brevis (main wrist extensor) and the extensor carpi ulnaris (main ulnar deviator). In such patients it has been suggested not to use the flexor carpi ulnaris as donor for extensor digitorum. Instead, flexor carpi radialis has been suggested to be transferred to the extensor digitorum. Preserving the flexor carpi ulnaris is an effective way of preventing a severe radial deviation deformity but some patients still continue to have a radial deviation deformity especially in wrist extension. Techniques described to prevent the radial deviation deformity include - transfer of the extensor carpi radialis longus to brevis for more central wrist extension; transfer of extensor carpi radialis longus to the third metacarpal or transection and transfer of the extensor carpi ulnaris to the extensor carpi radialis.

Methods: We have performed brachioradialis to extensor carpi ulnaris transfer to address the radial deviation deformity in these patients. It is much simpler and is much more effective as it restores the normal radio-ulnar balance of the wrist by providing a dynamic ulnar stabilizer. Moreover, there is no donor muscle deficit as brachioradialis is always available in these patients and is an expendable tendon.

Results and Conclusions: This tendon transfer was performed in five patients with good results in all. All patients could do an active ulnar deviation and extension. None had radial deviation deformity at the wrist. A balanced wrist was achieved in all the patients resulting in excellent cosmesis and function.