Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries

Jayme A Bertelli; Harsh R Shah; Christopher S Crowe

doi:10.1016/j.jhsa.2023.11.025

Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries

J Hand Surg Am. 2024 Jan 12:S0363-5023(23)00644-5. doi: 10.1016/j.jhsa.2023.11.025. Online ahead of print.

Authors

Jayme A Bertelli¹, Harsh R Shah², Christopher S Crowe³

Affiliations

¹ Department of Traumatology and Orthopedics, Governador Celso Ramos Hospital, Florianópolis, SC, Brazil; Department of Surgery, Federal University of Santa Catarina, Florianópolis, Brazil. Electronic address: drbertelli@gmail.com.
² Department of Traumatology and Orthopedics, Clinical Hand Surgery Fellow, Governador Celso Ramos Hospital, Florianopolis, Santa Catarina, Brazil; Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
³ Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA.

PMID: 38219087
DOI: 10.1016/j.jhsa.2023.11.025

Abstract

Purpose: Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy. To address wrist radial deviation, we propose transferring the anconeus muscle, extended by the intermuscular septum between the ECU and the flexor carpi ulnaris (FCU), to the ECU tendon.

Methods: Through an incision over the ulna, the intermuscular septum between the ECU and FCU is harvested at the level of the periosteum and left attached to the anconeus proximally. The anconeus muscle is then released from the ulna, and the intramuscular septum extension is sutured to the ECU tendon under maximal tension. Anconeus muscle transfer was performed on two patients to correct chronic wrist radial deviation following PT to ECRB tendon transfer for radial nerve injury, as well as on two patients with PIN paralysis. In four patients, transfer was performed in addition to standard tendon transfers for radial nerve paralysis to prevent radial wrist deviation deformity.

Results: Wrist radial deviation was corrected or prevented in all but one patient at an average follow-up of 10 months. Patients with PIN lesions and those who had anconeus transfer concomitantly with radial nerve tendon transfers were capable of active ulnar deviation. No patient experienced elbow extension weakness, pain, or instability.

Conclusions: Anconeus muscle transfer extended by intermuscular septum presents a viable alternative for addressing radial deviation of the wrist in cases of PIN nerve lesions or following PT to ECRB tendon transfer in radial nerve paralysis.

Type of study/level of evidence: Therapeutic V.

Keywords: Posterior interosseous nerve injury; radial nerve injury; radial wrist deviation; tendon transfer.