Concurrent Nerve and Tendon Transfers in a Tetraplegic Patient: Long-Term Functional Recovery and Late Hardware-Associated Flexor Pollicis Longus Rupture

Tetraplegia is a significant impairment of mobility in all four limbs, often following a cervical spinal cord injury. Recent studies in the management of tetraplegia describe the use of nerve transfer in addition to tendon transfer for upper extremity rehabilitation. While the popularity of these techniques is growing, there are limited studies describing the long-term outcomes and functional recovery following such procedures. This case describes a patient who sustained a C7 spinal cord injury, right olecranon fracture, and left distal radius fracture following a fall. Surgeons performed open reduction and internal fixation for the extremity fractures. The C7 injury resulted in loss of digital flexion and extension as well as significant weakness in his right elbow. Two years after the initial injury, surgeons performed a nerve and tendon transfer procedure, with significant postoperative improvements in right elbow flexion and bilateral pinch and grasp functions. Four years after the initial trauma, the patient returned with a recent loss of thumb interphalangeal flexion caused by a left flexor pollicis longus rupture secondary to hardware from the distal radius fixation. His subsequent treatment included surgical intervention for hardware removal and intercalated autograft. This case serves to guide the future surgical management of tetraplegia with insight into the complications and long-term outcomes of concurrent nerve and tendon transfer.