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Long-Term Outcomes of Biceps Rerouting for Flexible Supination Contractures in Children With Brachial Plexus Birth

M Claire Manske1, Cory Pham2, Sandra L Taylor3

  • 1Department of Orthopedic Surgery, Shriners Hospital for Children Northern California, Sacramento, CA; Department of Orthopedic Surgery, University of California Davis Sacramento, CA.

The Journal of Hand Surgery
|December 26, 2021
PubMed

Insights

Biceps rerouting surgery effectively improves forearm supination contractures in children with brachial plexus birth injuries (BPBI). This procedure enhances active pronation and reduces supination, with results maintained long-term and a low complication rate.

Area of Science:

  • Pediatric Orthopedics
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Forearm supination contractures affect 7% of children with brachial plexus birth injuries (BPBI).
  • Biceps rerouting is indicated when pronation has deteriorated but remains passively correctable to neutral.
  • Evaluating long-term outcomes is crucial for this surgical intervention.

Purpose of the Study:

  • To assess the long-term effectiveness of biceps rerouting in children with BPBI.
  • To evaluate the magnitude and maintenance of correction in forearm rotation.
  • To determine complication rates and the need for subsequent osteotomy.

Main Methods:

  • Retrospective review of children with BPBI and forearm supination contractures treated with biceps rerouting (1993-2017).
  • Inclusion criteria: passive pronation correctable to at least 0°, minimum 2-year follow-up.
  • Analysis of pre- and postoperative active pronation, supination, elbow flexion contracture, and arc of forearm rotation using mixed-effect models.

Main Results:

  • Twenty-five children (mean age 7 ± 3 years) were followed for 6 ± 3 years.
  • Significant improvement in active pronation (6° to 39°) and decrease in active supination (62° to 18°) observed.
  • No significant change in the arc of forearm rotation or elbow flexion contracture; 8% required subsequent osteotomy.

Conclusions:

  • Biceps rerouting effectively improves forearm position in BPBI by shifting the arc towards pronation.
  • The procedure does not decrease the overall range of motion or worsen elbow flexion contractures.
  • Early intervention may prevent severe contractures and reduce the need for further surgery.
Abstract

Keywords:
Biceps reroutingbrachial plexus birth injuryforearm contracturesupination contracture

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