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  4. The scope of upper limb surgery for tetraplegics: Role of tendon transfers and Universal Cuff

The scope of upper limb surgery for tetraplegics: Role of tendon transfers and Universal Cuff

Acta Orthopaedica et Traumatologica Turcica, 2017 · DOI: http://dx.doi.org/10.1016/j.aott.2017.06.002 · Published: October 4, 2017

Spinal Cord InjurySurgeryRehabilitation

Simple Explanation

This study explores surgical options for improving hand function in individuals with tetraplegia (paralysis of all four limbs). The primary focus is on tendon transfer procedures and the use of a Universal Cuff as a salvage method. Tendon transfers involve surgically rerouting tendons to restore specific hand functions like key pinch and hook grip. The effectiveness of these transfers was measured in terms of strength and functional outcomes. The Universal Cuff is presented as a helpful tool for patients who experience complications or are not suitable candidates for further surgery, providing a means to perform daily tasks.

Study Duration
26 months
Participants
12 tetraplegic patients (21 upper limbs)
Evidence Level
Level IV, Therapeutic study

Key Findings

  • 1
    Tendon transfer surgeries resulted in average key pinch strength of 1.67 kg and hook grip strength of 2.58 kg at the final follow-up.
  • 2
    The Modified Lamb and Chan score indicated good to fair functional outcomes in 75% of the patients who underwent surgery.
  • 3
    The Universal Cuff proved to be a useful salvage method for patients experiencing complications or refusing re-surgery after initial tendon transfer procedures.

Research Summary

The study evaluated the effectiveness of tendon transfers for restoring hand function in tetraplegic patients, specifically focusing on key pinch and hook grip. Results showed improvements in grip strength and functional outcomes, with the Universal Cuff offering a solution for managing complications or patient refusal of further surgery. The authors conclude that surgery should be considered for tetraplegic patients with deficient hand function, and the Universal Cuff can be a valuable tool in managing post-operative challenges.

Practical Implications

Surgical Intervention

Surgery should be considered a viable option for improving hand function in tetraplegic patients when no further spontaneous recovery is expected.

Rehabilitation

Post-operative rehabilitation is crucial for maximizing the benefits of tendon transfer surgeries and should involve a dedicated team approach.

Assistive Devices

The Universal Cuff can serve as an effective assistive device for patients who experience surgical complications or decline further surgical interventions.

Study Limitations

  • 1
    Small sample size
  • 2
    Short survival of tetraplegics
  • 3
    Limited patient resources and access to healthcare

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