STRATEGY and INDICATIONS

STRATEGY and INDICATIONS

Group 6


SITUATION (see table)	Remaining functions	active flexion and extension of the elbow active pronation and supination of the forearm active and strong extension and flexion of the wrist active extension of fingers MP joints
	Paralysed functions	active flexion of the fingers intrinsic functions of the fingers all extrinsic and intrinsic functions of the thumb
	Muscles available for transfers	BR ECRL (ECRI) PT (ECU in 1 case out of 2) EDM




SUGGESTED SURGICAL PROGRAM (2 stages)	1st surgical stage	intrinsic palliative of the fingers (4 indirect lassos powered by ECU if this muscle is active, otherwise 4 direct lassos) restoration of index MP extension (side-to-side suture of EDC2 to other EDC tendons at the level of the distal forearm) EPL tenodesis thumb stabilisation (NZ tenodesis, or IP arthrodesis) (sometimes APL crossed dynamic tenodesis)	Postoperative immobilization : 4 weeks (elbow in flexion at 90°, wrist in extension, fingers MP joints in flexion)
SUGGESTED SURGICAL PROGRAM (2 stages)	2nd surgical stage	restoration of fingers flexion (ECRL to FDP transfer) restoration of pinch closure (BR-to-FPL transfer)	Postoperative immobilization : 4 weeks (elbow in flexion at 90°, wrist in flexion, fingers MP joints in flexion)