New Functional Evaluation Scheme - Modality of the Results of Forearm Tendon Transfers Evaluation in Cases of Irreparable Radial Nerve Injury.

introductionThere are several evaluation schemes for the results of tendon transfers in case of radial nerve paralysis, and the most logical and commonly used are evaluation schemes that use the range of active joint movements to evaluate the results.

aimPresent an original evaluation scheme for tendon transfer results based on functional wrist and fingers joint movements. The aim of the article is to present the advantages of our own Functional scheme in comparison with other schemes, its simplicity and applicability in the evaluation of all clinical cases of different postoperative outcome of the variables being evaluated, and to present the ease of comparison of the achieved results with other authors who would possibly use our scheme because it minimizes the subjective error of the examiner. The secondary aim is to compare the results of flexor carpi radialis (FCR) vs. flexor carpi ulnaris (FCU) tendon transfers (TT).

methodsThe study was conducted as clinical and retrospective. The study included 60 patients with isolated radial nerve palsy operated by two tendon transfer surgical methods (FCR and FCU) over a 10-year period. The evaluation of the results was performed by using Zachary, Neimann-Pertecke, Tajima evaluation schemes, our own Functional Evaluation Scheme as well as subjective patient evaluation.

resultsThe time elapsed from injury to surgery ranged from 105 to 956 days in case of FCR tendon transfer and from 109 to 712 days in cases of FCU tendon transfer. The overall average age of patients is 36.71 years. A statistically significant difference in values with t -test based on the Functional Evaluation Scheme was found in the variables of ulnar deviation (p=0.000731), extension of the MP fingers joints II-V (p=0.04610) and extension of the MP of the thumb joint (p=0.0475). Evaluation of the total results with t-test (p=0.007532) and with U-test (p=0,00433) showed statistically better FCR tendon transfer results. A statistically significant difference in value measured by the t-test was found in the evaluation of the overall results (p=0.022) with Zachary and Neumann-Pertecke schemes and by the Tajima evaluation Scheme (p=0.042) in favor of better FCR tendon transfer results. With a use of Functional Evaluation Scheme, it is possible to evaluate all the results unlike most available schemes.

conclusionThe functional evaluation scheme is based on the functional joint movements evaluated and incorporating radial and ulnar deviation of the wrist (RD and UD), extension of the metacarpophalangeal (MCP) joint and flexion of the intephalangeal (IP)joint of the thumb in the final evaluation becomes completely original. A functional evaluation scheme is simply applicable for the evaluation of all clinical cases of different postoperative outcome of the variables being evaluated. FCR tendon transfer achieves better results than FCU TT.