title: Outcome after tendon transfers to restore wrist extension in children with brachial plexus birth injuries.
abstract: Children with brachial plexus birth injuries often require tendon transfer to restore active wrist extension and maximize hand function. The purpose of this study is to assess the clinical results in children with brachial plexus birth injuries after tendon transfer to reconstruct active wrist extension. Over a 10-year period, 21 children (11 male, 10 female) underwent tendon transfer to reconstruct active wrist extension by a single surgeon. Eight patients had C5/C6/C7 injury and 13 patients had global palsy (C5-T1). The average age at surgery was 5.5 years (range, 3 to 8 y). Restoration of wrist extension was measured according to the functional scale of Duclos and Gilbert. The mean duration of follow-up was 36 months (minimum follow-up of 1 y). At latest follow-up, 14 (66%) children (C5/C6/C7, n=8; global, n=6) demonstrated active wrist extension ≥ 30 degrees. Within the global injury subcohort, 3 patients demonstrated static extension of the wrist. Four failures occurred in the global palsy group. Children with absent active wrist extension after a brachial plexus birth injury can benefit from a tendon transfer. The more severe global palsy cases have a worse outcome.
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Ruchelsman
authors.forename: Lorna E
authors.initials: LE
authors.lastname: Ramos
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Price
authors.forename: Leslie Agatha
authors.initials: LA
authors.lastname: Grossman
authors.forename: Herbert
authors.initials: H
authors.lastname: Valencia
authors.forename: John A I
authors.initials: JA
authors.lastname: Grossman
mesh_terms: D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013709:Tendon Transfer / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D014955:Wrist Joint / Q000473:pathology / Q000601:surgery*