Treatment of the supination deformity in the pediatric brachial plexus patient

A supination deformity of the forearm can occur after brachial plexus palsy. The initial deformity is correctable; however, a fixed deformity often develops over time. Fixed supination creates difficulties with activities of daily living, impairs tenodesis grasp and gravity release, and limits the ability to perform bimanual activities. In the supple or passively correctable forearm, restoring active supination via tendon transfer frequently leads to better function. The fixed supination deformity, however, is not amenable to tendon transfer. An osteotomy of the radius and/or ulna is necessary to reposition the limb into pronation. A biceps transfer may be performed at the same time to further balance the forearm and prevent recurrence. This article describes our preferred surgical technique for both supple and fixed supination deformities of the forearm.