One-bone forearm osteodesis and biceps re-routing to correct severe supination contracture ina paediatric patient with late obstetric brachial plexus palsy.

Abstract

The one-bone forearm arthrodesis has been performed to change the position of the forearm in children with fixed supination deformity due to upper extremity neurologic deficit. In this article, we present a retrospective review of children with late obstetric brachial plexus palsy who underwent palliative surgery to correct severe supination contracture by one-bone forearm osteodesis and biceps re-routing. This technique has not been described previously. In this retrospective study, four consecutive patients with upper extremity weakness and severe supination contracture who underwent forearm osteodesis in neutral or slight pronation and biceps re-routing. The average age of patients at the time of surgery was 12years six months (range, 7-14years). The average follow-up was one year ten months (range, 1year 6months to 2years 7months). The rotation of the forearm set in neutral (3 patients) and 15° pronation (1 patient). No patients noted adverse effects on the shoulder, elbow or wrist, and none missed having forearm rotation. One-bone forearm osteodesis and biceps re-routing technique should be considered in some patients with fixed forearm supination deformity and concomitant severe pronation deficit. In this group of patients, repositioning the forearm in a more pronated (or less supinated) position may improve the use of that extremity in activities of daily living. The surgical technique is fairly simple and can be done in a single procedure.