title: Use of the Green transfer in treatment of patients with spastic cerebral palsy: 17-year experience.
abstract: We retrospectively reviewed Green procedures and transfer of the flexor carpi ulnaris (FCU) in treatment of spastic forearm pronation, wrist volarflexion, and ulnar deviation deformities. Patient's ages ranged from 3 years 5 months to 16 years 5 months. Surgically, a single volar incision was made and the extensor carpi radialis brevis and/or longus (ECRB, ECRL) were used for insertion. The FCU was tensioned at neutral against gravity and immobilized in 5 degrees of dorsiflexion and 45 degrees of supination. Arc of flexion (47 degrees) did not change but was centered about neutral. Supination improved markedly when operation included a pronator procedure. Quadraplegia athetosis and intellectual impairment did not affect the operative result adversely. Patients aged greater than 12 years showed less functional improvement. Eighty-eight percent had cosmetic improvement, and 79% improved functionally. None had a decreased functional rating.
authors.affiliation: Shriners Hospitals for Crippled Children, St. Louis, Missouri.
authors.forename: W R
authors.initials: WR
authors.lastname: Beach
authors.forename: W B
authors.initials: WB
authors.lastname: Strecker
authors.forename: J
authors.initials: J
authors.lastname: Coe
authors.forename: P R
authors.initials: PR
authors.lastname: Manske
authors.forename: P L
authors.initials: PL
authors.lastname: Schoenecker
authors.forename: L
authors.initials: L
authors.lastname: Dailey
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D005260:Female; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications*; D012189:Retrospective Studies; D013709:Tendon Transfer / Q000379:methods*; D013710:Tendons / Q000601:surgery; D014955:Wrist Joint