Pronator teres rerouting transfer as an alternative to green's transfer in cerebral palsy patients

Background Hand function limitations are common in all types of cerebral palsy (CP) secondary to wrist-flexion deformity and forearm pronation. Flexion posture of the wrist decreases the mechanical advantage of digital flexor tendons, causing weak grip, weak pinch, and precluding a normal visual feedback of the hand. The Green's transfer using flexor carpi ulnaris to extensor carpi radialis brevis (ECRB) tendon transfer was a gold-standard procedure to correct the flexed position of the wrist and adding to supination power of the forearm, but after wide use of this procedure over the years, many cases with reversal of deformity were developed, but making any further help for those patients is very difficult. That arouses the need of other procedures to avoid this serious complication after Green's procedure. Patients and methods From 2008 to 2011 in 51 CP forearms in 37 patients (7-16 years old) with wrist flexion and ulnar deviation deformity and forearm pronation deformity, the authors assessed the results of PT tendon transfer to ECRB after rerouting of the muscle through the interosseous membrane according to hand function, improvement of daily activity, grip strength, and esthetics with at least 8 years of follow-up. Preoperatively, all patients are examined and only patients with at least a neutral wrist position and midprone position of the forearm passively can be reached and were included in the study. Results After a final assessment of all patients after a 8-year follow-up, we have comparable results to Green's procedure for wrist extension flexion range, active supination, hand function, and grip strength, with no reversal of deformity in any of the patients with a shorter procedure with a small single-forearm incision. Conclusion PT transfer to ECRB in CP patients with flexion and pronation deformity of the forearm can replace the Green procedure with avoidance of miserable complication of reversal of deformity, especially in skeletally immature patients. Type of study/level of evidence Therapeutic IV