Long Head of the Triceps Transfer to the Proximal Ulna for Active Elbow Flexion in Arthrogryposis.

Abstract

Children with amyoplastic arthrogryposis may have absent myotomes (e.g., biceps brachii, brachialis), leading to a lack of active elbow flexion and/or elbow extension contractures. In these cases, the long head of the triceps can be transferred through an extensile approach to the proximal volar ulna, improving both active and passive elbow flexion. Key technical considerations include patient selection, preservation of the long head's neurovascular pedicle, precise dissection of the radial and ulnar nerves, and safe tendon rerouting. This paper highlights technical details with a representative case example and an accompanying technique video. A 6-year-old patient with amyoplasia and absent active flexion underwent a long head of the triceps transfer. The procedure was documented with surgeon point-of-view high-definition footage to emphasize crucial technical steps. Passive and active elbow flexion improved at short-term follow-up and was sustained at 2 years.

Key concepts: (1)Elbow flexion can be improved through long head of triceps transfer in children with amyoplastic type of arthrogryposis.(2)Use of one head of the triceps adds elbow flexion and does not sacrifice elbow extension function as the medial and lateral heads of the triceps are preserved as elbow extensors.(3)Most children with arthrogryposis have demonstrated clinically that they can achieve selective control of the long head of the triceps to flex the elbow post-operatively, while relaxing the medial and lateral heads of the triceps for elbow extension.(4)The long head of the triceps originates from the scapula and has separate radial nerve branch proximal innervation allowing dissection away from the other two heads of the triceps.(5)Careful dissection and understanding of the anatomy of the three heads of the triceps is needed for successful surgical transfer of the long head of the triceps.