Tendon Transfer for Persistent Radial Nerve Palsy Using Single-Split FCU Technique and Re-Routing of Extensor Pollicis Longus: A Prospective Study of 25 Cases.

Abstract

Purpose:Optimal treatment of persistent radial nerve palsy is controversial. However, most authors agree that tendon transfers lead to satisfactory result in majority of patients. Triple tendon transfer using flexor carpi radialis, pronator teres, and palmaris longus is the most preferred tendon transfer. The aim of this study was to evaluate the results of a split flexor carpi ulnaris (FCU) as a single transfer in such patients and compare our results with other transfers from the available literature.Materials and Methods:A total of 25 patients (20 males and 5 females: mean age: 30.9 years) were selected for FCU split transfer in persistent radial nerve palsy injury from April 2014 to May 2015. All patients were followed up with a mean followup of 1 year. Clinical outcomes were assessed using Bincaz score.Results:Using Bincaz score, 68% of our patients had good-to-excellent result, while 32% patients had fair and none had bad results. Wrist extension was comparatively less in high radial nerve palsy as compared to low radial nerve palsy patients, but all patients were functionally independent. Power grip was assessed using a jammer dynamometer. All patients had adequate grip strength and good active extension of the wrist and fingers.Conclusion:Single transfer using split FCU can be a preferred alternative in patients of low radial nerve palsy, it can be considered for high radial nerve patients in whom multiple donors are absent due to the nature of injury, for example, brachial plexus injury.