Tomasz Drobnik and Felix Franke: Who Was the First in History to Treat Radial Nerve Palsy by Tendon Transfer?

Abstract

Sir: Korteweg et al. recently answered the question “Who Was the First in History to Treat Radial Nerve Palsy by Tendon Transfer?”1 by naming the Polish surgeon Tomasz Drobnik in 1894. We thank the authors for their insightful review of the early history of tendon transfer, yet would like to share with the readers some objections to the conclusions drawn, which seem disputable in historical and terminological regard. As Drobnik writes in his original work,2 he performed a two-stage procedure in a little girl with postpoliomyelitis paralysis in her forearm and hand muscles, but preserved function of the extensor carpi radialis longus and extensor carpi radialis brevis. He first partly transferred the extensor carpi radialis longus to the extensor digitorum, with unsatisfactory outcome. Later, he continued with a partial transfer of the extensor carpi radialis brevis to the extensor pollicis longus, ultimately achieving an acceptable result. Consequently, Drobnik performed partial tendon transfers in postpoliomyelitis paralysis, which has only remote similarity to classic radial nerve palsy, as both wrist extensors (extensor carpi radialis brevis and extensor carpi radialis longus) innervated by the radial nerve were intact. He used exactly these very two muscles as donors to reanimate finger and thumb extension, which are naturally no candidates for tendon transfer in radial nerve palsy. However, Drobnik published his idea in a then widely read surgical journal and obviously inspired a colleague to transfer his approach from poliomyelitis to radial palsy, which had never been treated by tendon transfer before. In 1896, Felix Franke (1860 to 1937) from Braunschweig, Germany, quoted Drobnik and recommended transferring the flexor carpi ulnaris to the extensor digitorum communis tendons, shortening (tenodesis) of the extensor carpi radialis tendon, and further transfer of the flexor carpi radialis tendon to the abductor and short extensor to restore thumb extension.3 Two years later, he reported on two cases of tendon transfer in radial palsy.4 He provided details regarding an 8-year-old girl with “the typical features of radial nerve palsy: impossibility to extend the hand (and first finger phalanx), to supinate the hand, … the hand drops down flaccidly when the arm is elevated.” On July 27, 1897, he performed tendon transfer surgery, and after 10 days of plaster immobilization, the girl achieved full active finger extension and flexion with overall “very favourable” function. Notably, electrophysiologic testing confirmed permanent lack of any excitability of the entire extensor muscles and the radial nerve. Franke reasoned that “there is no incurable radial nerve palsy, as long as the median and ulnar nerve remain nonparalyzed. Radial palsy, at least in functional regard, is curable by operation.” In conclusion, we think that both Tomasz Drobnik and Felix Franke deserve credit for their application of tendon transfers to the arm and hand—previously used exclusively in the lower extremity. If someone asked who first in history treated radial nerve palsy with tendon transfers, a Solomonic answer might be: Felix Franke in 1897—inspired by Tomasz Drobnik's idea from 1894. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Andreas Gohritz, M.D. Karsten Knobloch, M.D., Ph.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany Jan Fridén, M.D., Ph.D. Hand Surgery Sahlgrenska University Hospital Göteborg, Sweden