Swan neck deformities are common in children with cerebral palsy. Deformities are considered a result of muscle imbalance caused by an over activity of the extrinsic wrist flexors combined with intrinsic muscle spasticity in the hand. There are multiple surgical techniques described to correct swan neck deformity. No long term data exists on any procedure in this patient population. The aims of this study were to two-fold. First, to assess the success rate of lateral band translocation at minimal of 5 year follow-up. Second, to assess any relationship between recurrence rate and concomitant surgical procedures.
The cohort consisted of 69 fingers in 29 consecutive patients with an average age of 21 years. All patients had hemiplegic spastic type cerebral palsy. A variety of classification systems were used to assess hand function. The indications for surgery were dysfunction or pain. Functional disability was attributed to locking of the PIP joint in extension. Four patients were lost at follow-up and 62 fingers in 25 consecutive patients were available for review.
Correction of the swan neck deformity was successful in 84% of the operated fingers at one year. The successful correction decreased to 60% at 5 years. No relationship was found among any of the concomitant surgical procedures and number of patients with recurrence.
The authors stress the difficulties in treating swan neck deformity in children with cerebral palsy. The precise imbalance leading to swan deformity may be variable across this patient population. The use of lateral band translocation provided 84% correction at one year follow-up. However, the correction was successful in only 60% at five year follow-up. This report highlights that lateral band translocation according to their technique is disappointing and does not provide long lasting success.