THE JOURNAL OF HAND SURGERY VOL. 32E SUPPLEMENT 114

Materials and Methods: Twelve adolescent patients withhemiplegic cerebral palsy were reviewed followingsurgery for a grossly flexed spastic wrist joint (Zancolli3). The mean age was 13 years and patients complainedof the appearance of the hand/wrist and poor function.All patients had undergone a synchronous wristarthrodesis with plate fixation, coupled with a proximalrow carpectomy to effectively ‘shorten’ the carpus.Mean follow-up was four years and all patients wereassessed independently in the hand therapy unit wherefunctional and patient satisfaction outcomes wererecorded.Results: All 12 wrists fused without complication, withprimary wound healing. Modest functional benefit wasnoted in nine of the 12 patients with some improvementin coordination of the fingers and better release but nosignificant thumb improvement. All patients were verysatisfied with the appearance of the wrist and hand postsurgery.Conclusion: We would advocate this approach in thesurgical management of this difficult problem. Modestfunctional gain and significant improvement in thecosmesis of the wrist and hand is very beneficial andstabilising the wrist segment allows other secondaryprocedures to try and improve finger and thumbfunction at a later date.

10.1016/j.jhse.2007.02.091

A-0087

3.6 BRACHIORADIALIS RE-ROUTING FOR RE-

STORATION OF ACTIVE SUPINATION AND COR-

RECTION OF FOREARM PRONATION DEFORMITY

IN CEREBRAL PALSY

T. Ozkan, S. Tuncer, A. Aydin, H. U. Aydin andZ. HosbayFrom the Istanbul Faculty of Medicine, Department of

Plastic and Reconstructive Surgery, Division of Hand

Surgery, Istanbul University, Istanbul, Turkey

Background: Pronation deformity is one of the mostcommon and also one of the most disabling deformitiesin cerebral palsy, as it interferes with daily activitiesrequiring supination.Aim: To investigate the results of brachioradialis re-routing procedure for the restoration of active supina-tion in patients with cerebral palsy.Patients and methods: Brachioradialis muscle re-routingprocedure was performed to restore active supination in20 children with cerebral palsy. Following release ofpronator quadratus and lengthening of pronator teresmuscles, brachioradialis tendon is separated from itsdistal origin and dissected generously from all fascialattachments to increase excursion. Next, the distal partof the tendon is passed through the interosseous space ina volar to dorsal direction and reinserted to the radius.

Results: Mean pre-operative supination was �37.81 (lessthan neutral) and increased to 48.11 (beyond neutral).The procedure resulted in a gain of 211% in activesupination. Due to release on the pronator mechanism,mean pronation decreased from 78.41 to 52.31, however,this decrease did not impair function.Conclusions: Brachioradialis re-routing supinatorplastyin this series has given satisfactory results and ispresented as an alternative method for restoration offorearm supination in cerebral palsy.

10.1016/j.jhse.2007.02.092

A-0312

3.7 INTRAOPERATIVE MEASUREMENT OF

MUSCLE PROPERTIES REVEAL A RELATIONSHIP

BETWEEN MUSCLE REMODELING AND CON-

TRACTURE FORMATION

E. Ponten and R. LieberFrom the Department of Pediatric Orthopaedic Surgery,

Astrid Lindgren Children’s Hospital, Karolinska Univer-

sity Hospital, Stockholm, Sweden, the Departments of

Orthopaedics and Bioengineering, Biomedical Sciences

Graduate Group, University of California, USA and the

Veterans Administration Medical Centers, San Diego,

USA

Background: The development of muscle contracturesrepresents a serious surgical and therapeutic challenge.Unfortunately, structural and functional changes that occurin muscles that cause the contracture, are poorly understood.Aims: The aim was to elucidate if there was anycorrelation between wrist contracture and sarcomerelength in children with cerebral palsy (CP).Methods: We developed a tool to measure musclesarcomere length (Ls) in children with CP and thenmeasured flexor carpi ulnaris (FCU) sarcomere lengthprior to tendon transfer surgery (n ¼ 17 children).Measurements from the FCUs of radial nerve injurypatients were used as ‘‘control’’ values to representnormally-innervated muscle. Prior to surgery, the degreeof contracture was assessed by measuring the extent ofpassive wrist motion. Then, during surgery, the FCUmuscle belly was exposed and small fiber bundlesisolated by blunt dissection. Laser diffraction wasperformed and sarcomere length was measured by usingthe 71st order spacing distance.Results: Intraoperative Ls were extremely long in spasticFCU muscles compared to normal FCUs from radial7nerve injury patients (4.670.3mm vs. 2.970.2mm).Importantly, there was a highly significant correlationbetween the degree of contracture and the intraoperativesarcomere length (r ¼ 0.70, Po0.005). Specifically, thegreater the contracture, the longer the measured Ls. Therelationship between degree of contracture (in degrees) andintraoperative Ls was: y (1) ¼ 15.5� Ls (1/mm)+1301.