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Derotation osteotomy of the forearm in management of paralytic supination deformity
1Department of Hand Surgery, Kaplan Hospital, Rehovot, Israel.
Insights
Pronation osteotomy improved forearm supination deformity in children with obstetric paralysis. This surgery enhanced hand function for grasping, with promising results from additional biceps tendon rerouting.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Obstetric paralysis can lead to forearm supination deformity in children.
- This deformity significantly impairs hand function, particularly grasping ability.
Purpose of the Study:
- To evaluate the effectiveness of pronation osteotomy in correcting forearm supination deformity in children with obstetric paralysis.
- To assess the functional outcomes, including grasping ability and range of motion, following the surgical intervention.
Main Methods:
- Ten children with supination deformity underwent pronation osteotomy of the radius and ulna.
- Two patients also had release of the interosseous membrane.
- Preliminary data on biceps tendon rerouting in three patients were analyzed.
Main Results:
- Pronation osteotomy significantly improved the resting position of the forearm.
- This improved position provided a mechanical advantage for grasping medium-sized objects.
- Biceps tendon rerouting, in conjunction with or after osteotomy, showed encouraging results, with one patient gaining 135 degrees of active pronation.
Conclusions:
- Pronation osteotomy is an effective surgical option for correcting forearm supination deformity in pediatric obstetric paralysis.
- The procedure enhances functional hand use, particularly for grasping.
- Combined with biceps tendon rerouting, it offers potential for significant gains in active pronation.
Abstract:
Ten children with supination deformity of the forearm due to obstetric paralysis were treated by pronation osteotomy of the radius and ulna. In two patients release of the interosseous membrane was added. The main achievement of the operation was an improved position of rest, which rendered a mechanical advantage for the basic function of the hand in grasping medium-sized objects. Preliminary results of three other patients who recently underwent rerouting of the biceps tendon concurrently or following the osteotomy are encouraging. One patient who had both procedures underwent rerouting of the biceps, which resulted in a gain of 135 degrees of active pronation.