[Restoration of elbow flexion by tendon transfer in traumatic paralysis of the brachial plexus in adults. Apropos of 44 injured patients].

Forty-four post traumatic paralyses of the brachial plexus were operated on to restore elbow flexion using tendon transfers. On 19 occasions, the plexus had been explored surgically with 10 neurolyses and 9 nerve repairs. Eight patients had a second tendon transfer, the first one having failed. Twenty-two Steindler flexor plasties were performed, the medial epicondyle being transferred upwards by an average of 4.5 cms. Details of treatment are described by which secondary displacement of the transplanted medial epicondyle can be avoided. On 5 occasions the results were poor. Pectoralis minor was transferred 8 times with 5 failures due to the difficulty of appreciating the preoperative strength of the muscle and because of technical problems. The technique should only be used in C5-C6 lesions. On 14 occasions the triceps was transferred with 14 successes. The simultaneous contraction of biceps and triceps was advantageous. The results of all kinds of transfers were much better after C5-C6 paralysis than after C5-C6-C7 lesions. For correction of medial rotation deformity, osteotomy appeared to be safer than tendon transfer.