A 25-year-old man has a complete radial nerve injury at the spiral groove of the humerus following a humeral shaft fracture. After 18 months, there is no recovery. Electromyography shows denervation potentials with no reinnervation in the extensor digitorum communis. Nerve grafting is no longer feasible. Which is the MOST appropriate reconstructive option to restore wrist and digit extension?

• A Wrist drop splint and physiotherapy to maintain passive movement
• B Free functioning muscle transfer (gracilis) to restore wrist extension
• C Tendon transfers: pronator teres to ECRB, FCR to EDC, and palmaris longus to rerouted EPL ✓
• D Arthrodesis of the wrist in slight extension with no tendon transfer

Explanation

When radial nerve recovery is absent at 18 months and EMG confirms irreversible denervation, tendon transfer is the standard reconstructive option to restore wrist and digital extension. The classic triple transfer for radial nerve palsy: (1) pronator teres → ECRB (wrist extension); (2) FCR → EDC (finger extension); (3) palmaris longus → rerouted EPL (thumb extension). These transfers use expendable median/ulnar-innervated motors. Free muscle transfer is a salvage option when no local donors are available. Wrist arthrodesis eliminates tenodesis function. Splinting alone is palliative.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.