Z-Plastik und Umleitung der Bizepssehne mit Release der Membrana interossea zur Wiederherstellung der Pronation bei lähmungsbedingten Supinationsfehlhaltungen und -kontrakturen

Rühmann, O.; Hierner, R.

doi:10.1007/s00064-009-1703-x

Cited by 6 publications

(1 citation statement)

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“…Hoffer and Phipps (2010) [ 8 ] suggested that EFC may be caused by deformation of the elbow joint or imbalance of the muscles or a combination of both [ 8 ]. Insufficient power (<M4) of the triceps was reported to cause flexion contracture of the elbow [ 9 ]. EFC seems to be caused by brachialis muscle pathology [ 10 ], and this is not an osseous abnormality.…”

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confidence: 99%

Significant improvement in nerve conduction, arm length, and upper extremity function after intraoperative electrical stimulation, neurolysis, and biceps tendon lengthening in obstetric brachial plexus patients

Nath

Somasundaram

2015

J Orthop Surg Res

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BackgroundProgressive loss of extension and concomitant bony deformity of the elbow are results of persistent biceps contracture in obstetric brachial plexus injury (OBPI) patients, if they do not fully recover. This adversely affects the growth and development and functions of the upper extremity.Patients and methodWe have performed biceps tendon lengthening (BTL) using a Z-plasty technique on OBPI patients aged 4 years to adulthood, who had been diagnosed with biceps tendon fixed flexion contractures. Ulnar, radial, and median nerve decompression was also performed at the same sitting. Somatosensory evoked potential (SSEP) monitoring was performed by stimulating the median and ulnar nerves at the wrist and the radial nerve over the dorsum of the hand and recording the peripheral, cervical, and cortical responses.Seven children with obstetric brachial plexus palsy with an average age of 11 years (8.7–14.2 years) were included in this report. Mean follow-up time was 7.4 months (4–11 months). All the patients in this report had the elbow flexion contractures greater than 30°.ResultsMean flexion contracture was 35° (30°–45°) preoperatively, which was improved to 0°–10° postoperatively with an average follow-up of 7 (4–11) months. This surgical procedure corrected the elbow flexion contractures, about an average of 25° and an improved length almost to normal, and improved the upper extremity functions. Neurophysiological data showed significant improvement in conduction of all three nerves tested after neurolysis. Further, median and radial nerve amplitude increase was statistically significant.ConclusionStatistically significant improvement in biceps length as well as nerve conduction was observed after the surgery. None of the children in our study lost biceps function, although weakness of the biceps is both a short- and long-term risk associated with biceps lengthening.

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