The Journal of Bone and Joint Surgery, Vol 76, Issue 10 1451-1456, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Single-stage reconstruction of key pinch and extension of the elbow in tetraplegic patients
SD Paul, H Gellman, R Waters, G Willstein and M Tognella
Rancho Los Amigos Medical Center, Downey, California.
The results in ten arms of nine patients who had post-traumatic tetraplegia
at the fifth or sixth cervical level were reviewed after combined transfer
of the brachioradialis to the flexor pollicis longus and of the posterior
part of the deltoid to the triceps tendon to restore key pinch and
extension of the elbow. The average age of the patients was twenty-nine
years, the average time from the injury to the operation was five years,
and the average duration of follow-up was thirty-one months. Key pinch
improved from essentially none preoperatively to an average of 2.0 pounds
(0.9 kilogram) postoperatively: an average of 3.0 pounds (1.4 kilograms)
for the patients who had tetraplegia at the sixth cervical level and an
average of 0.9 pound (0.4 kilogram) for those who had tetraplegia at the
fifth cervical level. Key pinch was favorably influenced by extension of
the wrist, while the position of the elbow had no effect. Maximum active
extension of the elbow against gravity was within 20 degrees of full
extension in eight of the ten arms. There was an improvement in the
performance of activities of daily living, including wheelchair use, and
most of the patients discontinued use of special equipment for the upper
extremity. The results of this study, when compared with those of each
procedure performed separately, suggest that a combination of the
operations improves function of the upper extremity and shortens the
duration of dependence postoperatively.