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International Orthopaedics

, Volume 42, Issue 8, pp 1975–1978 | Cite as

One-bone forearm osteodesis and biceps re-routing to correct severe supination contracture in a paediatric patient with late obstetric brachial plexus palsy

  • Ricardo Monreal
Original Paper

Abstract

Purpose

The one-bone forearm arthrodesis has been performed to change the position of the forearm in children with fixed supination deformity due to upper extremity neurologic deficit. In this article, we present a retrospective review of children with late obstetric brachial plexus palsy who underwent palliative surgery to correct severe supination contracture by one-bone forearm osteodesis and biceps re-routing. This technique has not been described previously.

Materials and methods

In this retrospective study, four consecutive patients with upper extremity weakness and severe supination contracture who underwent forearm osteodesis in neutral or slight pronation and biceps re-routing. The average age of patients at the time of surgery was 12 years six months (range, 7–14 years).

Results

The average follow-up was one year ten months (range, 1 year 6 months to 2 years 7 months). The rotation of the forearm set in neutral (3 patients) and 15° pronation (1 patient). No patients noted adverse effects on the shoulder, elbow or wrist, and none missed having forearm rotation.

Conclusions

One-bone forearm osteodesis and biceps re-routing technique should be considered in some patients with fixed forearm supination deformity and concomitant severe pronation deficit. In this group of patients, repositioning the forearm in a more pronated (or less supinated) position may improve the use of that extremity in activities of daily living. The surgical technique is fairly simple and can be done in a single procedure.

Keywords

One-bone forearm Supination deformity Arthrodesis Osteodesis Brachial plexus 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical Committee.

Informed consent

Informed consent was obtained from all participants.

References

  1. 1.
    Steindler A (1918) Orthopaedic reconstruction work on hand and forearm. N Y Med J 108:1117–1119Google Scholar
  2. 2.
    Zancolli EA (1967) Paralytic supination contracture of the forearm. J Bone Joint Surg Am 49(7):1275–1284CrossRefPubMedGoogle Scholar
  3. 3.
    Owings R, Wickstrom J, Perry J, Nickel VL (1971) Biceps brachii re-routing in treatment of paralytic supination contracture of the forearm. J Bone Joint Surg Am 53(1):137–142Google Scholar
  4. 4.
    Manske PR, McCarroll HR, Hale R (1980) Biceps tendon re-routing and percutaneous osteoclasis in the treatment of supination deformity in obstetrical palsy. J Hand Surg Am 5(2):153–159Google Scholar
  5. 5.
    Blount WP (1940) Osteoclasis for supination deformities in children. J Bone Joint Surg Am 22(2):300–314Google Scholar
  6. 6.
    Zaoussis AL (1963) Osteotomy of the proximal end of the radius for paralytic supination deformity in children. J Bone Joint Surg Br 45(3):523–527CrossRefPubMedGoogle Scholar
  7. 7.
    Lin HH, Strecker WB, Manske PR, Schoenecker PL, Seyer D (1995) A surgical technique of radioulna osteoclasis to correct severe forearm rotation deformities. J Pediatr Orthop 15(1):53–58CrossRefPubMedGoogle Scholar
  8. 8.
    Murray RA (1955) The one-bone forearm: a reconstructive procedure. J Bone Joint Surg Am 37(2):366–370CrossRefPubMedGoogle Scholar
  9. 9.
    Castle ME (1974) One-bone forearm. J Bone Joint Surg Am 56(6):1223–1227CrossRefPubMedGoogle Scholar
  10. 10.
    Reid RL, Baker GI (1973) The single-bone forearm—a reconstructive technique. Hand 5(3):214–219CrossRefPubMedGoogle Scholar
  11. 11.
    Chan PSH, Blazer PE, Bozentka DJ, Gonzales JB, Naranja RJ, Boros B (1999) Optimal position for the one-bone forearm. J Hand Surg Br 24(6):724–726CrossRefPubMedGoogle Scholar
  12. 12.
    Wang AA, Hutchinson DT, Coleman DA (2001) One-bone forearm for pediatric supination deformity. J Hand Surg Am 26(4):611–616CrossRefPubMedGoogle Scholar
  13. 13.
    Aitken J (1952) Deformity of the elbow joint as a sequel to Erb’s obstetric paralysis. J Bone Joint Surg Br 34(3):352–365CrossRefPubMedGoogle Scholar
  14. 14.
    Chomiak J, Dungl P, Ošťádal M, Frydrychová M, Burian M (2014) Muscle transfers in children and adults improve external rotation in cases of obstetrical brachial plexus paralysis: a comparative study. Int Orthop 38(4):803–810CrossRefPubMedGoogle Scholar
  15. 15.
    Kruit AS, Choukairi F, Mishra A, Gaffey Andrew A, Jeste A (2016) Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study. Int Orthop 40(4):783–790CrossRefPubMedGoogle Scholar
  16. 16.
    Yam A, Fullilove S, Sinisi M, Fox M (2009) The supination deformity and associated deformities of the upper limb in severe birth lesions of the brachial plexus. J Bone Joint Surg Br 91(4):511–516CrossRefPubMedGoogle Scholar
  17. 17.
    Hankins SM, Bezwada HP, Kozin SH (2006) Corrective osteotomies of the radius and ulna for supination contracture of the pediatric and adolescent forearm secondary to neurologic injury. J Hand Surg Am 31(1):118–124CrossRefPubMedGoogle Scholar
  18. 18.
    Weekley H, Nikolaou S, Hu L, Eismann E, Wylie C, Cornwall R (2012) The effects of denervation, reinnervation, and muscle imbalance on functional muscle length and elbow flexion contracture following neonatal brachial plexus injury. J Orthop Res 30(8):1335–1342CrossRefPubMedGoogle Scholar
  19. 19.
    Soldado F, Fontecha CG, Marotta M et al (2014) The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model. J Shoulder Elb Surg 23(7):1003–1009CrossRefGoogle Scholar
  20. 20.
    Noonan KJ, Price CT (1998) Forearm and distal radius fractures in children. J Am Acad Orthop Surg 6(3):146–156CrossRefPubMedGoogle Scholar
  21. 21.
    Metsaars WP, Biegstraaten M, Nelissen RGHH (2017) Biceps re-routing after forearm osteotomy: an effective treatment strategy for severe supination deformity in obstetric plexus palsy. J Hand Microsurg 9(1):1–5Google Scholar
  22. 22.
    Metsaars WP, Henseler JF, Nagels J, Nelissen RG (2017) Supination contractures in brachial plexus birth palsy: long-term upper limb function and recurrence after forearm osteotomy or nonsurgical treatment. J Hand Surg Am 42(11):925 e1-e11CrossRefPubMedGoogle Scholar
  23. 23.
    Bachoura A, Jacoby SM, Lee Osterman A (2013) One-bone forearm procedure for Hajdu–Cheney syndrome: a case report. Hand 8(4):479–482CrossRefPubMedGoogle Scholar
  24. 24.
    Botteri G, Castellana A (1961) Distal first metatarsal osteodesis procedure in hallux valgus correction [in Italian]. Clin Ortop 13:139Google Scholar
  25. 25.
    Wang AA, Jacobsen-Petrov J, Stubin-Amelio L, Athanasian EA (2000) Selection of fusion position during forearm arthrodesis. J Hand Surg Am 25(5):842–848CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Clínicas Maison de SantéLimaPeru

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