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Surgical correction of supination deformity in children with obstetric brachial plexus palsy
Insights
Surgical correction of supination contracture in children with obstetric brachial plexus palsy improved forearm positioning. Procedures like radial osteotomy and biceps rerouting effectively corrected the "begging hand" deformity, enhancing function.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Surgery
Background:
- Severe obstetric brachial plexus palsy (OBPP) can lead to significant supination contractures.
- These deformities result in a non-functional and cosmetically concerning "begging hand" posture.
- Surgical intervention is often necessary to improve upper extremity function.
Purpose of the Study:
- To evaluate the effectiveness of surgical interventions for supination contracture in children with OBPP.
- To assess the functional and positional outcomes following radial osteotomy and biceps rerouting.
- To determine the long-term stability of surgical corrections.
Main Methods:
- Retrospective review of 40 children operated for supination contracture post-OBPP.
- Procedures included open/closed radial osteotomy (23 cases) and biceps rerouting (17 cases).
- Average age at surgery: 7 years; mean follow-up: 4 years.
Main Results:
- Radial osteotomy achieved a mean intraoperative derotation of 78 degrees, with final pronation stabilizing at 17 degrees.
- Biceps rerouting prevented recurrence of supination deformity, achieving a final position of 22 degrees pronation.
- Some active forearm rotation was regained in a subset of patients.
Conclusions:
- Surgical correction of supination contracture in OBPP is effective in improving forearm positioning.
- Both radial osteotomy and biceps rerouting offer viable solutions for this challenging deformity.
- These procedures contribute to a more functional and aesthetically improved upper extremity in affected children.
Abstract:
We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78 degrees, the immediate postoperative position was 29 degrees pronation and it stabilized at follow-up at 17 degrees pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22 degrees pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the "begging hand" to be corrected to a more functional and less noticeable position.
