A case report of surgical treatment of traumatic drop hand by quadruple tendons transfer

INTRODUCTION: Drop hand is the case of inability to dorsiflexion of the hand and fingers according to radial nerve palsy (complete syndrome) or PIN (Posterior Interosseous Nerve) palsy (partial syndrome). Therefore, the patient loses part of the normal function of his/her hand causing life problems especially if it is the dominant hand. Tendon transfer is the main surgical treatment. CASE REPORT: We present a case of a young male who sustained multiple traumatic war injuries especially in the left upper limb; open humerus fracture, open ulna fracture, open radius fracture with a clear drop hand syndrome. After quadruple tendons transfer, he got a very good result especially in thumb movements with good ROM (Range Of Motions) in the wrist. DISCUSSION: Since it is difficult to restore full ROM and full muscular strength in the wrist and fingers of a drop hand with triple tendon transfer routinely, especially in the case of multiple injury to the upper extremity with the pronator teres being nonfunctional, we decided to perform quadruple tendon transfer depending on the tendons; FCR, PL, 3rdFDS, 4thFDS for stronger extension of the wrist, thumb, and other fingers. CONCLUSION: Our aim here is to confirm that the drop hand does not have standard findings in all cases. It may be a challenge, and may have atypical findings especially in the case of ipsilateral multiple traumatic limb, which in turn may have weakness or restriction in some important movements, so, it is important to keep in mind alternatives of tendon transfer.