STEINDLER AND PECTORALIS MAJOR FLEXORPLASTY - A COMPARATIVE-ANALYSIS

Previously published studies on transfers to restore elbow flexion hav e rarely compared the outcomes among different techniques. We found no comparison between the Steindler procedure and pectoralis major tendo n transfer. This study compared functional outcomes after these two ty pes of elbow flexorplasty performed in conjunction with shoulder arthr odesis for patients with brachial plexus injuries. The same examiner a ssessed 14 patients who underwent shoulder fusion and elbow flexorplas ty. Five had a pectoralis major tendon transfer, and nine underwent a modified Steindler procedure. All patients had brachial plexus lesions that were irreparable or had not responded to neurolysis, repair, or grafting. Average follow-up time was 60 months (range, 12 months-10 ye ars). All patients completed a questionnaire (pain, function) and unde rwent an objective assessment of range of motion, isometric strength, isotonic power, grip, and pinch strength. The BTE Work Simulator (Balt imore Therapeutic Equipment, Hanover, MD) was used for muscle strength testing. Improvement was noted in daily activities including dressing and bilateral activities and was reflected in a significant improveme nt over preoperative function. No differences (at p = .05 level of sig nificance) were found in objective tests between the pectoralis major transfer and the Steindler groups. In the patient requiring stabilizat ion of the shoulder and flexorplasty, the pectoralis major tendon tran sfer was at least equivalent to the modified Steindler flexorplasty in terms of range of motion, strength, and subjective measures.