PURPOSE: The purpose of the study was to assess the outcomes of flexor digitorum superficialis (FDS) transfer for wrist extension restoration in patients with residual brachial plexus birth injury.
METHODS: A retrospective analysis was conducted on patients 4 years or older who underwent FDS transfer between January 2008 and February 2024. Clinical records were reviewed to evaluate preoperative wrist extension deficit, postoperative outcome, and complications. The main outcome measurement was the British Medical Research Council scale to assess postoperative wrist extension strength.
RESULTS: Seventy-three patients were included in the study. The average age was 7.5 years (range, 4-16 years). Mean follow-up was 45.0 ± 34 months (range, 6-129 months). The FDS tendon route and the chosen metacarpal for attachment evolved over the course of the study period. The FDS transfer resulted in considerable improvement in wrist extension, with 89% of patients achieving wrist extension with power grip (M4 grade wrist extension) after surgery. Interosseous membrane-routed FDS transfers and patients with preoperative M3 wrist extension strength had a greater-than-expected rate of M4 wrist extension strength after surgery. Complications included swan neck deformity, ulnar deviation, radial deviation, supination contracture, and pronation contracture.
CONCLUSIONS: The FDS transfer is an effective technique for restoration of wrist extension in patients with residual brachial plexus birth injury. The technique provides outcomes comparable or superior to other traditional tendon transfer techniques in this population based on reports in the literature. Patients with greater preoperative wrist extension strength may have more reliable increases in wrist extension strength after surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
Read the article: PubMed · Publisher (DOI)