In order to evaluate the efficacy of single or combined surgical procedures for correction of a frequent combination of forearm pronation and wrist flexion deformities in spastic cerebral palsy, a retrospective study was performed on 22 patietns
who had
undergone Green's flexor carpi ulnaris (FCU) transfer alone, or Green's FCU transfer with rerouting of pronator teres, or pronator release combined with procedures, depending on the degree of pronation contracture. The mean age at the time of
surgery
was 9 years and 8 months (range:4 years and 5 months-21 years and 7 months). The mean follow-up was 3 years and 1 month (range : 1 year-7 years 1 month). The patients were classified into 3 groups according to the type of operations. The first
group
consists of 8 cases with active supination to neutral and passive supination over 60° preoperatively. Green's flexor carpi ulnaris (FCU) transfer was performed and mean gain of active supination was 42.6°. The second group consists of 5 cases
with
active supination less than neutral and passive supination between 10°-60° preoperatively. Green's FCU transfer and rerouting of pronator teres were performed and mean gain of active supination was 60.3°. The third group consists of 8 cases
with
active supination less than neutral and passive supination less than 10° preoperatively. Gree's FCU transfer with pronator release (stripping of interosseous membrane and pronator quadratus) and rerouting of pronator teres were performed and
mean
gain
of active supination was 66.4°.
At follow-up, the mean active wrist dorsiflexion was 40.8°, palmar flexion 31.5°, forearm supination 49.1° and pronation 43.6°. Arc of motion was centered about neutral. According to a modified Green and Banks' evaluation criteria, the
functional
results were 7 excellent, 8 good, and 7 fair.
In conclusion, forearm pronation and wrist flexion deformities in spastic cerebral palsy patients could be corrected effectively by a single or combined surgical procedures according to the degree of forearm pronation contracture.
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