FLEXORPLASTY OF THE ELBOW

An Evaluation of a Method

¹ New York Orthopardic Hospital at the Columbia-Presbyterian Medical Center, New York

In reviewing the results in twenty-seven flexorplasties, the authors were impressed with the value of the operation. When at all possible, it is greatly to be preferred to other methods of restoring active flexion to the elbow.

A fixed flexion deformity of about 40 degrees should be expected. It is a functional position. There should be no hesitation from the viewpoint of appearance, for this angle does not constitute a cosmetic defect.

A tendency toward a pronated position of the forearm should be expected. If the supinators are strong, there will be balance. Insertion of the transplanted flexor mass into a more anterior position on the humerus was found to be an aid in diminishing this tendency. The use of the flexor carpi ulnaris as a supinator is also a method of preventing forearm pronation.

Great care must be given to evaluating the power of the flexor-pronator group of muscles prior to operation. The power located in the superficial flexor mass of the forearm is the most important. The power of these muscles is increased by arthrodesis of the wrist.

Knowledge of the technique of this operation should be exact. Adequate distal mobilization along the superficial flexor-muscle mass is most important. The adjacent nerves must be protected. The mass should be transplanted proximally and anteriorly on the humeral shaft. Secure fixation to the new site is mandatory. Utilization of cortical defects, such as drill holes, is helpful in achieving this fixation.

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