A Modification to the Brand Transfer for Claw Hand: The Four-Tailed Extensor Carpi Radialis Brevis to Lateral Band Transfer

Abstract

Background: Claw deformity is a devastating consequence of low ulnar nerve palsy, resulting in loss of finger function. Traditionally, the Brand transfer is a favored intervention but requires lengthy grafts and bulky tenorrhaphies, risking adhesions in the lumbrical canal. We present a modified Brand tendon transfer, which extends the extensor carpi radialis brevis (ECRB) into 4 tails for individual grafting into the lateral band, decreasing adhesion risk and graft length need. Methods: Nine consecutive patients with claw hand were examined in detail to confirm the diagnosis and appropriateness for claw-correction surgery by the senior author. All patients underwent our modified Brand transfer. Follow-up for a minimum of 6 months was pursued for each patient, with range of motion, grip strength, and pinch strength recorded at that time. Results: Treated patients demonstrate maintained grip and pinch strength, coordinated grasp, and improvement in metacarpophalangeal posture. One patient required reoperation for extensive scarring and underwent tenolysis of the tendon grafts and revision grafting for the small finger. Conclusion: We concluded that our modified weave of a 4-tailed tendon graft through the ECRB is a synergistic transfer that maintains acceptable hand strength in the setting of a chronic low ulnar nerve palsy with a lower risk of tendon adhesion and length of grafting, offering an additional tool in the armamentarium of the hand surgeon approaching the ulnar nerve–injured hand.