Pronator teres transfer for forearm and wrist deformity in cerebral palsy children.

BACKGROUND

Forearm pronation and wrist flexion contracture can be a disability for daily living care and 2-hand function in cerebral palsy (CP) children. It may be beneficial to improve their posture and hand-grip power for better functional outcome. The purpose of our study was to investigate the outcome of pronator transfer in CP children.

METHODS

Seventeen spastic CP patients (14 hemiplegic, 3 diplegic; 14 male, 3 female; mean age, 12 y 5 mo) underwent pronator teres transfer for forearm pronation and wrist flexion contractures. The mean follow-up period was 46 months. We recorded Gross Motor Function Classification System level, modified Ashworth scale, forearm and wrist range of motion, forearm resting position, grip power, and 3 basic daily living skills preoperatively and postoperatively. Paired t test was used for statistical analysis.

RESULTS

The average forearm active supination gained 80.9 degrees (P<0.05) and the active forearm pronation lost 22 degrees (P<0.05), with average postoperative total active forearm range of motion 130.9 degrees (P<0.05). The average active wrist extension gained 76.9 degrees (P<0.05) and the active wrist flexion lost 31.8 degrees (P<0.05). The average grip power gained 4.5 kg (P<0.05). The average forearm resting position improved to 10 degrees pronation (P<0.05). The basic daily living skills showed great improvement.

CONCLUSIONS

Our procedure improved the functional outcome in wrist extension and decreased the forearm pronation. Therefore, significant grip-strength enhancement and better forearm posture was noted. It is an additional armamentarium in the management of upper extremity disability in CP children.

LEVEL OF EVIDENCE

Level IV-case series.