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Rotatory contracture of the forearm
The Journal of Bone and Joint Surgery. American Volume
|October 1, 1980
Summary
Idiopathic progressive loss of forearm supination in adolescents may involve quadrate ligament contracture. Surgical interventions addressing multiple forearm structures improved function in most patients.
Area of Science:
- Orthopedic Surgery
- Developmental Biology
Background:
- Progressive loss of forearm rotation, particularly supination, during adolescence is a challenging clinical issue.
- Idiopathic cases suggest complex etiologies beyond simple trauma.
Observation:
- Seven adolescent patients presented with progressive loss of forearm rotation, primarily supination.
- Four patients exhibited secondary developmental abnormalities, including radial head abnormalities and distal ulnar bowing.
- Surgical interventions involved quadrate ligament sectioning, interosseous membrane release, and distal ulna ostectomy.
Findings:
- Functional improvement was observed in four of the seven patients post-surgery.
- Quadrate ligament release offered the most significant functional improvement, though its isolated effect was minimal.
- Combined surgical approaches yielded better outcomes than isolated procedures.
Implications:
- Contracture of the quadrate ligament is a significant factor limiting forearm supination.
- Forearm rotational limitations result from a combination of factors including radial head distortion, ulnar curvature, and soft tissue contractures.
- Multifactorial surgical approaches may be necessary for optimal functional restoration in these complex cases.