E Peraut1, L Taïeb2, C Jourdan3, F Coroian3, I Laffont3, M Chammas2, B Coulet4. 1. Service de chirurgie de la main, du membre supérieur et des nerfs périphériques, CHU de Montpellier, 34295 Montpellier cedex 5, France; Euromov, université de Montpellier, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France. Electronic address: emmanuella.peraut@live.fr. 2. Service de chirurgie de la main, du membre supérieur et des nerfs périphériques, CHU de Montpellier, 34295 Montpellier cedex 5, France. 3. Service de médecine physique et de réadaptation, CHU de Montpellier, 34295 Montpellier cedex 5, France; Euromov, université de Montpellier, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France. 4. Service de chirurgie de la main, du membre supérieur et des nerfs périphériques, CHU de Montpellier, 34295 Montpellier cedex 5, France; Euromov, université de Montpellier, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France.
Abstract
INTRODUCTION: In hemiplegic patients with a spastic clenched fist deformity, one of the goals of surgery is to address the hygiene, nursing and appearance problems. Transfer of the flexor digitorum superficialis (FDS) to the flexor digitorum profundus (FDP), initially described by Braun and colleagues, opens the non-functional hand in these patients. The primary objective of our study was to confirm the effectiveness of this technique for correcting these deformities. The secondary objectives were to demonstrate potential functional gains and to identify potential complications. MATERIAL AND METHODS: A Braun procedure was performed in 26 patients (9 women, 17 men, ranging in age from 36 to 79 years). The overall appearance of the hand was graded using the Keenan classification system. Complications related to the surgery were documented. The hand's function was evaluated with the House score. RESULTS: The average follow-up was 47 months. Preoperatively, all patients had a class V hand: severe clenched-fist deformity with zero pulp-to-palm distance. Postoperatively, 10 patients had a type I hand (open hand, with less than 20° spontaneous extension deficit of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints) and 12 patients had a type II hand (20° to 40° spontaneous extension deficit of the MCP and PIP joints). The mean House score for all patients went from 0 to 0.88, and seven patients had functional improvements. Four patients had a forearm supination posture, 10 had intrinsic deformity with spontaneous MCP flexion and 6 had a swan-neck deformity. CONCLUSION: Superficialis-to-profundus tendon transfer (STP) provides satisfactory outcomes in terms of hand opening, with some patients also experiencing improved hand function. However, the complications cannot be ignored. LEVEL OF EVIDENCE: IV-retrospective or historical series.
INTRODUCTION: In hemiplegic patients with a spastic clenched fist deformity, one of the goals of surgery is to address the hygiene, nursing and appearance problems. Transfer of the flexor digitorum superficialis (FDS) to the flexor digitorum profundus (FDP), initially described by Braun and colleagues, opens the non-functional hand in these patients. The primary objective of our study was to confirm the effectiveness of this technique for correcting these deformities. The secondary objectives were to demonstrate potential functional gains and to identify potential complications. MATERIAL AND METHODS: A Braun procedure was performed in 26 patients (9 women, 17 men, ranging in age from 36 to 79 years). The overall appearance of the hand was graded using the Keenan classification system. Complications related to the surgery were documented. The hand's function was evaluated with the House score. RESULTS: The average follow-up was 47 months. Preoperatively, all patients had a class V hand: severe clenched-fist deformity with zero pulp-to-palm distance. Postoperatively, 10 patients had a type I hand (open hand, with less than 20° spontaneous extension deficit of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints) and 12 patients had a type II hand (20° to 40° spontaneous extension deficit of the MCP and PIP joints). The mean House score for all patients went from 0 to 0.88, and seven patients had functional improvements. Four patients had a forearm supination posture, 10 had intrinsic deformity with spontaneous MCP flexion and 6 had a swan-neck deformity. CONCLUSION: Superficialis-to-profundus tendon transfer (STP) provides satisfactory outcomes in terms of hand opening, with some patients also experiencing improved hand function. However, the complications cannot be ignored. LEVEL OF EVIDENCE: IV-retrospective or historical series.