Article

In hemiplegic patients with a spastic clenched fist deformity, one
of the goals of surgery is to address the hygiene, nursing and appearance
problems. Transfer of the flexor digitorum superficialis (FDS) to the flexor
digitorum profundus (FDP), initially described by Braun and colleagues, opens the
non-functional hand in these patients. The primary objective of our study was to
confirm the effectiveness of this technique for correcting these deformities. The
secondary objectives were to demonstrate potential functional gains and to
identify potential complications. MATERIAL AND METHODS: A Braun procedure was
performed in 26 patients (9 women, 17 men, ranging in age from 36 to 79 years).
The overall appearance of the hand was graded using the Keenan classification
system. Complications related to the surgery were documented. The hand's function
was evaluated with the House score. RESULTS: The average follow-up was 47 months.
Preoperatively, all patients had a class V hand: severe clenched-fist deformity
with zero pulp-to-palm distance. Postoperatively, 10 patients had a type I hand
(open hand, with less than 20 degrees spontaneous extension deficit of the
metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints) and 12
patients had a type II hand (20 degrees to 40 degrees spontaneous extension
deficit of the MCP and PIP joints). The mean House score for all patients went
from 0 to 0.88, and seven patients had functional improvements. Four patients had
a forearm supination posture, 10 had intrinsic deformity with spontaneous MCP
flexion and 6 had a swan-neck deformity. CONCLUSION: Superficialis-to-profundus
tendon transfer (STP) provides satisfactory outcomes in terms of hand opening,
with some patients also experiencing improved hand function. However, the
complications cannot be ignored. LEVEL OF EVIDENCE: IV-retrospective or
historical series.
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Langue : ANGLAIS