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Assessment of the Forearm Tendon Transfer with Irreparable Radial Nerve Injuries Caused by War Projectiles.
Med Arch. 2019 Dec; 73(6):415-420.MA

Abstract

Introduction

Injuries to the radial nerve can occur at any point along its anatomical route, and the etiology quite varies. A particular entity are war injuries of the extremities, which have high morbidity but low mortality. After irreparable radial nerve injury, the only treatment is tendon transfer (if we neglect arthrodesis) with over then 40 methods. Four tendon transfers are considered as better than the other and two of them are the subject of our article flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU).

Aim

To evaluate the ultimate functional results of forearm tendon transfers for irreparable radial nerve damage caused by war injuries and indicate the better operative treatment choice in accordance with the evaluation schemes.

Methods

This retrospective research included 40 patients with isolated irreparable radial nerve damage. Patients were operated from 1993 to 1996. The follow-up period is from 3.5 to 11.5 years (until 2007). Twenty patients were operated using FCR tendon transfer method and twenty patients were operated using FCU tendon transfer method. The surgery was performed at the Clinic for Reconstructive and Plastic Surgery, Clinical Center University of Sarajevo. Three score evaluation schemes were used: Zachary, Neumann Pertecke and Tajima scheme, along with subjective evaluation of treatment.

Results

Measured by the Zachary Evaluation Scheme, the overall score in patients undergoing FCR tendon transfer is 92.25%. In patients undergoing FCU tendon transfer, the total score was 82.20%. The total result of all 40 operated patients was 87.25%. The Zachary evaluation scheme showed a significant difference between FCR and FCU results by tendon transfer (p <0.05) in favor of the FCR tendon transfer. Tajima scheme proved a statistically significant difference between the two tendon transfers (p = 0.024), also in favor of FCR tendon transfers.

Conclusion

Forearm tendon transfer is a relevant method to compensate for the loss of function of the wrist, fingers and thumb extensions as a result of irreparable damage to the radial nerve. FCR tendon transfer provides better functional results than FCU tendon transfer in irreparable radial nerve damage. The time elapsed from the injury to the performed surgery of the tendon transfer has no effect on the final functional result. There is no surgical tendon transfer procedure that can be recommended as a standard for any patient. Practically, the surgeon must tailor the surgery to the patient's needs. It is necessary to develop a unique and generally accepted evaluation scheme for the results of tendon transfers that will enable comparisons of results achieved. Both methods can be used for irreparable damage of radial nerve due to any etiology.

Authors+Show Affiliations

Private Surgical Clinic «Karabeg», Sarajevo, Bosnia and Herzegovina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32082012

Citation

Karabeg, Reuf. "Assessment of the Forearm Tendon Transfer With Irreparable Radial Nerve Injuries Caused By War Projectiles." Medical Archives (Sarajevo, Bosnia and Herzegovina), vol. 73, no. 6, 2019, pp. 415-420.
Karabeg R. Assessment of the Forearm Tendon Transfer with Irreparable Radial Nerve Injuries Caused by War Projectiles. Med Arch. 2019;73(6):415-420.
Karabeg, R. (2019). Assessment of the Forearm Tendon Transfer with Irreparable Radial Nerve Injuries Caused by War Projectiles. Medical Archives (Sarajevo, Bosnia and Herzegovina), 73(6), 415-420. https://doi.org/10.5455/medarh.2019.73.415-420
Karabeg R. Assessment of the Forearm Tendon Transfer With Irreparable Radial Nerve Injuries Caused By War Projectiles. Med Arch. 2019;73(6):415-420. PubMed PMID: 32082012.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of the Forearm Tendon Transfer with Irreparable Radial Nerve Injuries Caused by War Projectiles. A1 - Karabeg,Reuf, PY - 2020/2/22/entrez PY - 2020/2/23/pubmed PY - 2020/7/2/medline KW - radial nerve palsy KW - tendon transfer KW - trauma KW - war injury SP - 415 EP - 420 JF - Medical archives (Sarajevo, Bosnia and Herzegovina) JO - Med Arch VL - 73 IS - 6 N2 - Introduction: Injuries to the radial nerve can occur at any point along its anatomical route, and the etiology quite varies. A particular entity are war injuries of the extremities, which have high morbidity but low mortality. After irreparable radial nerve injury, the only treatment is tendon transfer (if we neglect arthrodesis) with over then 40 methods. Four tendon transfers are considered as better than the other and two of them are the subject of our article flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU). Aim: To evaluate the ultimate functional results of forearm tendon transfers for irreparable radial nerve damage caused by war injuries and indicate the better operative treatment choice in accordance with the evaluation schemes. Methods: This retrospective research included 40 patients with isolated irreparable radial nerve damage. Patients were operated from 1993 to 1996. The follow-up period is from 3.5 to 11.5 years (until 2007). Twenty patients were operated using FCR tendon transfer method and twenty patients were operated using FCU tendon transfer method. The surgery was performed at the Clinic for Reconstructive and Plastic Surgery, Clinical Center University of Sarajevo. Three score evaluation schemes were used: Zachary, Neumann Pertecke and Tajima scheme, along with subjective evaluation of treatment. Results: Measured by the Zachary Evaluation Scheme, the overall score in patients undergoing FCR tendon transfer is 92.25%. In patients undergoing FCU tendon transfer, the total score was 82.20%. The total result of all 40 operated patients was 87.25%. The Zachary evaluation scheme showed a significant difference between FCR and FCU results by tendon transfer (p <0.05) in favor of the FCR tendon transfer. Tajima scheme proved a statistically significant difference between the two tendon transfers (p = 0.024), also in favor of FCR tendon transfers. Conclusion: Forearm tendon transfer is a relevant method to compensate for the loss of function of the wrist, fingers and thumb extensions as a result of irreparable damage to the radial nerve. FCR tendon transfer provides better functional results than FCU tendon transfer in irreparable radial nerve damage. The time elapsed from the injury to the performed surgery of the tendon transfer has no effect on the final functional result. There is no surgical tendon transfer procedure that can be recommended as a standard for any patient. Practically, the surgeon must tailor the surgery to the patient's needs. It is necessary to develop a unique and generally accepted evaluation scheme for the results of tendon transfers that will enable comparisons of results achieved. Both methods can be used for irreparable damage of radial nerve due to any etiology. SN - 1986-5961 UR - https://www.unboundmedicine.com/medline/citation/32082012/Assessment_of_the_Forearm_Tendon_Transfer_with_Irreparable_Radial_Nerve_Injuries_Caused_by_War_Projectiles_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32082012/ DB - PRIME DP - Unbound Medicine ER -