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The Flexor Pronator Slide: A Retrospective Study
Kristy L Hamilton, MD; Patrick Cole, MD; Kenneth W Donohue, MD; Kelly Verna, MOT, OTR; Aida Galinda, MOT, OTR; Andrea Jimenez, BA; David T. Netscher, MD
Baylor College of Medicine, Houston, TX

Introduction: The flexion contractures of the fingers, wrist and pronator muscles found in patients with a variety of CNS disorders are challenging to treat. The flexor pronator slide described by Page and Scaglietti is an often underutilized surgical technique, historically restricted for severe contractures in patients with voluntary control. This study’s goal was threefold: to understand the extent to which the technique improves wrist extension; to identify the indications for and scope of surgery; and to examine global hand functional outcomes following surgical intervention.
Materials and Methods: Ten consecutively operated hands in ten patients, average age 12.5 years (range, 3–17), underwent the flexor pronator slide using the Page-Scaglietti technique with average follow-up of 12.2 months (range, 6–26 months). Operated hands were compared to age/sex/dominant hand (ASDh)-matched norms and to their contralateral, non-operated hands, and patients reported their subjective outcomes. Functional pre- and post-operative videos were taken.
Results: Average follow-up was 12.2 months (range, 6–26 months) with 11 months of post-operative rehabilitation (range, 4–24 months). Post-operative wrist Volkmann’s Angle (VA) averaged 45° in extension (maximum 75°) having been acutely flexed preoperatively. There were no complications or further surgical intervention required, even though the technique was applied to contractures with a wide range of severity.

Patients’ wrist active range of motion (AROM) averaged 72% of normal, while wrist passive range of motion (PROM) averaged 82% of normal. Post-operative House classification scores averaged 5 (range: 3-8), and Zancolli scores averaged 1.47 (range 1-2A). Compared to (ASDh)-matched normative values, operated patients required a 270% (82–680%) increase in time needed to complete the Functional Dexterity Test and 350% more for the Jebsen Taylor Pickup Test.

Regarding grip strength, operated hands averaged 17% (range, 5–33%) of normal values and 49% (range, 7–111%) of patient contralateral, nonoperated hands. For tip pinch strength, operated hands averaged 26% (range 8–56%) of ASDh-matched norms and 66% (range, 17-156%) of patient contralateral, nonoperated hands. For key pinch, operated hands averaged 49% (range, 9–81%) of ASDh-matched norms and 72% (range, 19–123%) of patient contralateral, nonoperated hands.

Patients rated their pre- versus post-operative functional improvement (28%), appearance (87%) and satisfaction with outcome (94%). This was also borne out by video assessment.
Conclusion: The flexor pronator slide successfully treated all ten hands. Although challenging to treat, flexion contractures in spastic hands from mild to severe can benefit from the flexor pronator slide, preferentially when volitional control is maintained.

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