This articles reviews Steindler flexorplasties performed in 26 patients with obstetrical brachial plexus lesions and deficient elbow flexion. The average age at operation was 8 years, with a range from 3 to 16 years. The medial epicondyle and flexor mass was re-attached one inch proximally on the humeral shaft using a cortical screw or a bone anchor. The elbow was immobilized in 100° of flexion. A “very good” result was considered when there was 120° of active flexion, while a “good” result was considered when voluntary flexion was over 90°. Results indicate 3 very good, 18 good, and 5 failures. The authors conclude that Steindler flexorplasty provides reliable results despite lack of flexion power. Additional surgery may be required about the shoulder and hand to develop enhanced extremity use.
The authors support the use of this procedure over bipolar transfers to restore elbow flexion. However, their “good” result does not consider that functional elbow motion requires greater than 90° of elbow flexion. Diminished flexion is especially important when there is diminished compensatory shoulder motion. Although bipolar flexorplasties require more extensive dissection, they can often provide a more functional range of motion. In this regard, the Steindler flexorplasty is now more commonly used as an augmentary procedure following bipolar or free muscle transfer. Using it as a primary flexorplasty should be performed with caution if one expects to achieve greater than 120° of elbow flexion.