Biceps Rerouting after Forearm Osteotomy: An Effective Treatment Strategy for Severe Supination Deformity in Obstetric Plexus Palsy

Abstract

Retrospective cohort study. Supination deformity in obstetric brachial plexus injury can have debilitating consequences for the functionality of the hand. Surgical treatment by a forearm osteotomy has a recurrence rate of 20 to 42%. As a complement to forearm osteotomy, a biceps rerouting may improve outcome. Children with residual brachial plexus injury, who had a forearm osteotomy for a supination contracture and had a postoperative decrease of pronation to 50 degrees or less, were indicated for a biceps rerouting. Shoulder, elbow and hand function, biceps strength, Mallet score, and Raimondi score were assessed with a minimum follow-up of 2 years. Five patients (median age: 8 years; range: 4-10) underwent biceps rerouting between 2008 and 2012. Median follow-up time was 6.8 years (range: 3.2-7.0 years). Passive pronation increased in all cases (median 0 degree at baseline to 80 degrees at final follow-up). Active pronation also increased. Active median wrist extension was -30 degrees at baseline and 45 degrees at follow-up. Biceps strength and grip strength improved in two cases. No recurrences were present. The sequentially planned surgical treatment of forearm osteotomy and biceps rerouting should be considered in the treatment of severe supination deformity, as it is effective in improving pronation of the forearm and hand function, without recurrence at follow-up. Level III, case series, therapeutic study.

Forearm and elbow secondary surgical procedures in neonatal brachial plexus palsy: a systematic scoping review

“… bony 2006 12 1.33333 11 supination contracture osteotomy for supination contracture, fixed deformity Metsaars 28 Supination Contractures in Brachial Plexus Birth Palsy: Long-Term Upper Limb Function and Recurrence After Forearm Osteotomy or Nonsurgical Treatment. bony 2017 22 4.6 6 supination contracture osteotomy for supination contracture, fixed deformity Metsaars 27 Biceps Rerouting after Forearm Osteotomy: An Effective Treatment Strategy for Severe Supination Deformity in Obstetric Plexus Palsy. bony 2017 5 6.8 8 supination contracture salvage procedure after recurrence of supination deformity after forearm osteotomy, fixed deformity Van Kooten 20 Pronating radius osteotomy for supination deformity in children with obstetric brachial plexus palsy.…”

‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy

“…We observed correction of supination and ulnar deviation deformities during the early course of the follow-up period. Compared with other methods to restore pronation, this intervention provides less increase in active forearm rotation range of motion (Metsaars et al., 2014, 2017a, 2017b). This limitation of the extent of correction can also explain the low incidence of recurrence in our series.…”