Flexor-pronator slide

Indications

• Indications include established Volkmann ischemic contracture of the flexor-pronator muscles of moderate severity and a sustained functional impairment of the spastic upper extremity (resulting from central nervous system disorders such as cerebral palsy, traumatic brain injury [TBI], or cerebrovascular accident [CVA]) with fixed forearm pronation, wrist flexion, and finger flexion deformities.

Clinical examination

• It is important to ensure that the neurologic and orthopedic statuses are stable. For example, after CVA or TBI, there is a period of time (12–18 months) when there may be spontaneous functional improvement.

• Preoperative examination of the upper limb often reveals a fixed contracture of the forearm in pronation and a flexion contracture of the wrist and digits. In more severe digital flexion contractures, there may also be palmar skin breakdown. Grasp and release motions of the hand are severely impaired because of the wrist position.

• In Volkmann contractures, there are volar deep soft-tissue adhesions and fibrosis with or without peripheral nerve involvement. There is often some level of retained finger and thumb flexion.

Imaging

Radiographs of the forearm, wrist, and digits have limited use for preoperative planning before flexor-pronator slide.