Use of the Green transfer in treatment of patients with spastic cerebral palsy: 17-year experience

We retrospectively reviewed Green procedures and transfer of the flexor carpi ulnaris (FCU) in treatment of spastic forearm pronation, wrist volarflexion, and ulnar deviation deformities. Patient's ages ranged from 3 years 5 months to 16 years 5 months. Surgically, a single volar incision was made and the extensor carpi radialis brevis and/or longus (ECRB, ECRL) were used for insertion. The FCU was tensioned at neutral against gravity and immobilized in 5 degrees of dorsiflexion and 45 degrees of supination. Arc of flexion (47 degrees) did not change but was centered about neutral. Supination improved markedly when operation included a pronator procedure. Quadraplegia athetosis and intellectual impairment did not affect the operative result adversely. Patients aged greater than 12 years showed less functional improvement. Eighty-eight percent had cosmetic improvement, and 79% improved functionally. None had a decreased functional rating.