The Journal of Bone and Joint Surgery, Vol 57, Issue 2 196-206, Copyright © 1975 by Journal of Bone and Joint Surgery, Inc
Surgical treatment for absent single-hand grip and elbow extension in quadriplegia. Principles and preliminary experience
E Moberg
A classification of quadriplegic patients based on available sensory
receptors (ocular only or both ocular and hand sensibility) and motor
function in each upper extremity greatly facilitates the planning and
evaluation of surgical treatment. In forty hands of thirty-three patients
with post-traumatic quadriplegia and cord lesions higher than those usually
thought to be benefited by reconstructive surgery, three or more procedures
were performed at one or more sittings to create an active wrist extensor
and a thumb flexor grip, a function easier to provide and much more useful
to these patients than tripod pinch. In these forty hands no function was
lost and in all but two function was improved significantly if not greatly.
A useful level of active elbow extension was restored in fifteen of sixteen
extremities in quadriplegics by transfer of the posterior half of the
deltoid to the triceps aponeurosis, lengthening the deltoid with free
grafts from the toe extensors. Each upper extremity of quadriplegic
patients of the type under consideration is a highly individualized
problem. Successful treatment requires strict attention to every detail of
preoperative evaluation, surgical treatment, and postoperative care.
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