A fixation technique for the Steindler flexorplasty

Abstract

A curved longitudinal incision is made over the medial side of the elbow beginning 8 cm proximal to the medial epicondyle and extending distally posterior to the medial epicondyle, and then along the anterior surface of the forearm in line with the course of the pronator teres muscle. The medial antebrachial cutaneous nerve in the distal portion of the incision is identified and protected. The ulnar nerve is isolated and retracted posteriorly. The median nerve and its branches to pronator teres and flexor digitorum superficialis are identified. The median nerve and brachial artery are retracted laterally. Common origins are defined of the pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris at the medial epicondyle. The cortex of the medial epicondyle is drilled with a 2.0 mm drill bit. The epicondyle is then osteotomized, fashioning a 1.2 cm diameter, 1 cm deep, bone “plug” that is to be fixed subsequently to the anterior surface of the humerus. The flexor pronator muscles are freed distally for 5 to 6 cm taking care to preserve the median nerve branches to the pronator teres and flexor digitorum superficialis muscles and the ulnar nerve branches to flexor carpi ulnaris (Fig. 1, A). The brachialis muscle is split and the anterior surface of the humerus is exposed 5 to 7 cm proximal to the medial epicondyle. The mobility of the flexor pronator group is checked with the elbow in flexion to assure their proximal transfer without un-