32 patients with cerebral palsy underwent operations for pronation deformity. The deformity is classified into four groups. Patients in group 1 are capable of supination beyond neutral. No surgery is necessary. Those in group 2 are able to supinate to the neutral position. A pronator quadratus release is advised and may be combined with a flexor aponeurotic release. In group 3, patients have no active supination. However a full range of passive supination is readily achieved. A pronator teres transfer is advised. Patients in group 4 have no active supination. Full passive supination may be present, but is tight. A flexor aponeurotic release and a pronator quadratus release may unmask active supinator activity. An active transfer for supination is possible as a secondary procedure.

No abstract

No abstract

Volitionally modulated electroencephalographic (EEG) waves were monitored for the purpose of controlling a hand neuroprosthesis in people with tetraplegia. The region of the EEG signal spectrum monitored was the occipital alpha wave (8-13 Hz), and volitional modulation was achieved with the opening and closing of the eyes. In a set of 13 trials evaluated, a subject with tetraplegia successfully completed ten trials undertaking stimulated grasp and release using the EEG-triggered switch. EEG signal data recorded during the 13 trials were also post-processed off-line using wavepacket analysis. Following this signal processing, the speed and reliability of the EEG-triggered switch, when operated by the subject with tetraplegia, was significantly improved (p < 0.002). Such improvements provide system performance that is likely to be acceptable to a neuroprosthesis user during activities of daily life.

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

The use of intravenous guanethidine blocks is an accepted treatment for established reflex sympathetic dystrophy (RSD). Some units administer intravenous guanethidine peri-operatively with the intention of protecting their patients from post-operative dystrophy. There have been no studies confirming this protective effect of peri-operative guanethidine. Between 1992 and 1994 we performed a prospective randomized double blind study in 71 patients undergoing fasciectomy for Duputyren's disease. Peri-operative guanethidine did not prevent post-operative RSD in our series.

34 children with cerebral palsy had operations to correct flexion deformities of the wrist and fingers. 30 out of 34 patients were improved functionally and cosmetically. Zancolli's classification provides sound guidelines on which to base surgical decisions.

In a retrospective study, the results of 18 wrist fusions with a radial sliding graft and a dynamic compression plate are reviewed. All 18 fusions united, with an average position of 16 degrees of extension and 7 degrees of ulnar deviation. Wrist strength and stability and diminished pain allowed improved function. However, decreased maneuverability impaired function for some activities.