SINGLE-STAGE RECONSTRUCTION OF KEY PINCH AND EXTENSION OF THE ELBOW IN TETRAPLEGIC PATIENTS

The results in ten arms of nine patients who had post-traumatic tetrap legia at the fifth or sixth cervical level were reviewed after combine d transfer of the brachioradialis to the flexor pollicis longus and of the posterior part of the deltoid to the triceps tendon to restore ke y pinch and extension of the elbow. The average age of the patients wa s twenty-nine years, the average time from the injury to the operation was five years, and the average duration of follow-up was thirty-one months. Key pinch improved from essentially none preoperatively to an average of 2.0 pounds (0.9 kilogram) postoperatively: an average of 3. 0 pounds (1.4 kilograms) for the patients who had tetraplegia at the s ixth cervical level and an average of 0.9 pound (0.4 kilogram) for tho se who had tetraplegia at the fifth cervical level. Key pinch was favo rably influenced by extension of the wrist, while the position of the elbow had no effect. Maximum active extension of the elbow against gra vity was within 20 degrees of full extension in eight of the ten arms. There was an improvement in the performance of activities of daily li ving, including wheelchair use, and most of the patients discontinued use of special equipment for the upper extremity The results of this s tudy, when compared with those of each procedure performed separately, suggest that a combination of the operations improves function of the upper extremity and shortens the duration of dependence postoperative ly.