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Treatment of supination deformity for obstetric brachial plexus injury: a systematic review and meta-analysis
W P Metsaars1, J Nagels1, B G Pijls1
1Department of Orthopaedics and Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
Purpose:
To conduct a systematic review and meta-analysis of the literature evaluating treatment outcome for supination deformity in obstetric brachial plexus injury.
Methods:
We included studies on brachial plexus and supination deformity with follow-up of at least one year and quantitative measurements of forearm mean passive pronation and position at rest. Meta-analysis was used to explore modifying factors.
Results:
An elaborate search strategy resulted in 366 studies, of which 13 were included totaling 238 patients (157 osteotomies and 71 biceps rerouting). There was a 75° gain in position at rest and a 65° gain in passive pronation for the osteotomy group, compared to a 79° gain in position at rest for the biceps rerouting group. More severe deformities had greater gains. No influence of age was found. Important adverse effects were hardware failure and a biceps rupture. Recurrence in the osteotomy group was 20% to 40%, versus none in the soft-tissue group.
Conclusions:
This review showed an overall benefit for forearm osteotomies and for biceps rerouting for supination deformity with the gain proportionate to the severity of the deformity.
Type Of Study/Level Of Evidence:
Therapeutic III.
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