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Forearm supination deformity after obstetric paralysis.
Christian A Allende1, Alain Gilbert
1Institut de la Main (Clinique Jouvenet), Paris, France. christian_allende@hotmail.com
Clinical Orthopaedics and Related Research
|September 4, 2004
Summary
Radius osteotomies and soft tissue procedures can improve forearm supination in obstetric brachial plexus lesions. Optimal treatment selection depends on individual patient factors for best outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pediatric Neurology
Background:
- Persistent supination at rest is a common complication of obstetric brachial plexus lesions.
- Surgical interventions aim to improve forearm rotation and function in affected children.
Purpose of the Study:
- To evaluate the effectiveness of radius osteotomies versus soft tissue procedures for persistent supination.
- To identify optimal treatment indications based on patient-specific factors.
Main Methods:
- Retrospective review of 66 patients with obstetric brachial plexus lesions undergoing radius osteotomies or soft tissue procedures.
- Analysis of preoperative, intraoperative, and follow-up forearm positions and functional outcomes.
- Average follow-up periods of 64.3 months (osteotomy) and 72.57 months (soft tissue).
Main Results:
- Radius osteotomies showed significant improvement in forearm supination (preoperative 31°, intraoperative 114°, follow-up 92°).
- Soft tissue procedures did not show significant improvement (intraoperative 116°, follow-up 108°).
- Complications (delayed unions, nonunion, recurrences) were associated with radius osteotomies.
Conclusions:
- Radius osteotomies can effectively correct persistent supination, but carry a higher complication rate.
- Soft tissue procedures may offer less predictable rotational improvement.
- Treatment choice should be individualized based on forearm motion, joint condition, and overall functional status.