A surgical technique of radioulnar osteoclasis to correct severe forearm rotation deformities

Twenty-six forearms in 23 patients with marked pronation or supination deformities were treated with osteoclasis. Etiologies included 12 radioulnar synostoses, five brachial plexus injuries, three hemiplegias, two hemimelias, and four other types of deformities. Drill-assisted osteotomy of both the radius and ulna was followed 10 days later by manipulation to the desired functional position. Dominant extremities were placed in 20 degrees pronation, and nondominant extremities in 20 degrees supination. Range of motion was not significantly changed, but the arc of motion occurred in a more functional hand position. Average correction for 15 pronation deformities was 81 degrees and 69 degrees for 11 supination deformities. Two nonunions healed after bone grafting and there were no instances of neuromuscular compromise. Functional improvement was obtained in 25 of 26 forearms.