Comparison Of Effect Of Reconstruction Of Wrist Extension And Finger Extension With That Of Finger Extension In Cases Of Irreparable Brachial Plexus Injury

【Objective】A retrospective study was undertaken to assess the functional outcome of reconstruction of wrist extension and finger extension and that of finger extension by tendon transfer in cases of irreparable brachial plexus injury,and to compare the functional recovery of the two kinds of operation.【Material and Methods】25 patients who had clinically and electro-physiologically been confirmed irreparable brachial plexus injury and had reconstruction of wrist extension and finger extension or reconstruction of finger extension in Huashan Hospital in December 2003～May 2008 are involved in this research.Then the data of all of the cases were recorded.The data included the degrees of active wrist extension with fingers in fist position,wrist extension with fingers in extension position,and the muscle strengths of wrist extension;the degrees of active thumb IP joint extension, the degrees of MP joint extension with wrist in neutral position,the degrees of MP joint extension with wrist in extension position.Hand grip were measured using a dynamometer。Function was graded as excellent,good,fair or poor using the criteria for Functional recovery of radial nerve regularized by Chinese Medical Association in 2000.【Results】The results of the group of reconstruction of wrist extension and finger extension measured as follows:the mean range of wrist extension with fingers in fist position was 33.6 degrees(-5 degrees to 50 degrees),wrist extension with finger in extension position was 33.6 degrees(-5 degrees to 50 degrees),and muscle strengths of wrist extension were measured as follows:3+～4(n=6),3(n=3),2(n=1),and0～1(n=2).And The mean thumb IP joint extension was -7.3 degrees(-45 degrees to 0 degree ),The mean MP joint extension with wrist in neutral position was -8.5 degrees(-35 degrees to 0 degrees),The mean MP joint extension with wrist in extension position was -13.3degrees(-34degrees to 0 degree),The mean hand grip is 15.0 Kg(2.6～23.5Kg),in comparison with the contralateral hand,the mean ratio of hand grip is 39.7%(14.2%～58.8%).According to the criteria,the results of functional recovery were excellent in 5 patients(41.6%),good in 3 patients(25%), moderate in 3 patients(25%),and poor in 1 patient(7.3%).The results of the group of reconstruction of finger extension measured as follows: the mean range of wrist extension with fingers in fist position was 16.1 degrees(0 degree to 35 degrees),wrist extension with finger in extension position was -8.2 degrees(-20 degrees to 10 degrees),and muscle strengths of wrist extension were measured as follows:1(n=12),2(n=1).The mean thumb IP joint extension was -8.2 degrees(-20 degrees to 10 degrees ),the mean MP joint extension with wrist in neutral position was -10.8 degrees(-42 degrees to 0 degree),The mean MP joint extension with wrist in extension position was -9.2degrees(-42degrees to 0 degree), The mean hand grip is 9.6Kg(5.5～14.2Kg),in comparison with the contralateral hand,the mean ratio of hand grip is 22.4%(15.9%～29.2%).According to the criteria, the results were excellent in 0 patients(0%),good in 2 patients(15.3%),moderate in 10patients(76.9%),and poor in 1 patient(7%).The results of statistical analysis showed that no obvious difference between the two groups in the mean degrees of thumb IP joint extension(P=0.757),the mean MP joint extension with wrist in neutral position(P=0.592),the mean MP joint extension with wrist in extension position(P=0.184);however,there were significant difference between the two groups in wrist extension(P=0.029),the muscle strength of wrist extension(P＜0.001),wrist extension with finger in extension position,the mean hand grip(P=0.008) and the mean ratio of hand grip(P＜0.001).【Conclusions】Treatment of irreparable brachial plexus injury with reconstruction of finger extension by tendon transfers yields some improvement,extension of the MP joints of the fingers were similar to that of the normal hand.But in comparison with the contralateral hand,the range of extension of the wrist was less,and the recovery of hand grip is bad.Treatment with reconstruction of wrist extension and finger extension yields successful improvement of wrist extension and finger extension,but the recovery of hand grip is limited.Unless the tendon donor is limited,reconstruction of finger extension by tendon transfers for treatment of irreparable brachial plexus injury is not advised.