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Surgery for the Pronated Forearm and Flexed Wrist in Children with Cerebral Palsy

  • Maximillian MifsudEmail author
  • Jules Letherland
  • Rachel Buckingham
Original Article

Abstract

Aim

There is no consensus in the literature on how best to manage wrist flexion and forearm pronation deformities in children with cerebral palsy (CP). The aim of this research was to come up with a treatment algorithm for the surgical management of such cases.

Methods

Children with CP who underwent upper limb surgery between 2009 and 2016 at a single centre and by a single lead surgeon were reviewed retrospectively. Movement analysis and Shriners Hospital Upper Extremity Evaluation (SHUEE) data collected pre- and post-operatively.

Results

Thirteen patients were recruited. Most patients underwent a flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) transfer, with or without pronator teres (PT) re-routing, and finger flexor or elbow flexor releases. Mean increase in active range of supination was 40.8° (p = 0.002) and wrist extension 28.9° (p = 0.004). The mean increase in dynamic positional analysis (part of the SHUEE) was 25.4% (of which 40.3% was due the increases in wrist function and 16.8% due to forearm function). The loss of wrist flexion was not significant (p = 0.125). The mean follow-up was 14 months (range 9–21).

Conclusions

To tackle both a pronation and flexion deformity, the authors favour performing a FCU to ECRB transfer in isolation if there is active supination to neutral; if active supination is short of neutral, then a FCU to ECRB with a PT release and possible re-routing performed. A treatment algorithm is proposed.

Level of evidence

IV.

Keywords

Cerebral palsy Flexion Pronation FCU ECRB Paediatrics Movement analysis Surgery 

Notes

Author Contributions

MM: study design, data collection, statistical analysis and writing of paper. JL: data collection and writing of paper. RB: study design, statistical analysis and writing of paper.

Funding

None.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This manuscript represents honest and original work. The manuscript has been read and approved by all the authors.

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Copyright information

© Indian Orthopaedics Association 2020

Authors and Affiliations

  • Maximillian Mifsud
    • 1
    Email author
  • Jules Letherland
    • 1
  • Rachel Buckingham
    • 1
  1. 1.Department of Paediatric OrthopaedicsNuffield Orthopaedic CentreOxfordUK

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