STRATEGY and INDICATIONS

STRATEGY and INDICATIONS

Group 1


SITUATION (see table)	Remaining functions	active flexion of the elbow (BR grade 4)
	Paralysed functions	active extension of the elbow active extension and flexion of the wrist all extrinsic and intrinsic functions of the fingers and thumb
	Muscle available for transfers	BR only




SUGGESTED SURGICAL PROGRAM (2 stages)	1st surgical stage	Restoration of elbow extension (biceps-to-triceps transfer)
SUGGESTED SURGICAL PROGRAM (2 stages)	2nd surgical stage	restoration of active wrist extension (BR to ECRB transfer) reinforcement of tenodesis effect on key-grip (Allieu's EPL-FPL tenodesis) thumb stabilisation (NZ tenodesis, or IP arthrodesis) positionning index MP joint (lasso on index finger only)	Postoperative immobilization : 4 weeks (elbow in flexion at 90°, wrist in extension, fingers MP joints in flexion, thumb in abduction and antepulsion)