Correction of Complex Clawing after Cerebral Infarct via All-Dorsal ECRB Tendon Transfer using Four-Tailed Plantaris Autograft

Abstract

Clawing refers to pathologic hand posture of metacarpophalangeal joint hyperextension and proximal interphalangeal joint flexion, with variable presentation in appearance and functional deficits depending on underlying etiology, chronicity, and attempts at treatment. Characteristic deficits include the clawed appearance, loss of synchronous finger flexion, weakened grip and pinch strength, and impaired dexterity from loss of fine motor control. Surgical treatment varies for simple versus complex clawing, with additional nuances for associated pathology such as extensor mechanism attenuation, flexor myotendinous tightness, and intrinsic joint contracture. Conditions such as stroke or combined ulnar and median neuropathy require special consideration, as median-innervated myotendinous donors are not suitable. The present technique describes all dorsal extensor carpi radialis brevis tendon transfer via four-tailed plantaris autograft to the lateral bands for treatment of complex clawing after cerebral infarct.