Treatment of Supination Deformity for Obstetric Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Metsaars, Wieneke P.; Nagels, Jochem; Pijls, Bart G; Langenhoff, J.M.; Nelissen, Rob G H H

doi:10.1016/j.jhsa.2014.06.003

Cited by 12 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,7,9,[16][17][18][19] These results support the recommendation that in severe supination deformity, combining forearm osteotomy and biceps rerouting may improve outcome. 6 We did not find any disadvantages, except loss of supination, nor any complications with our strategy. The shoulder function was not affected by any of the surgical procedures of the forearm.…”

Section: Discussionmentioning

confidence: 61%

“…A forearm osteotomy is considered the first-choice treatment option in more severely affected children (i.e., passive pronation 50 degrees), while biceps rerouting was usually applied in case of mild deformity (i. e., passive pronation 50 degrees). 6 Experts have discussed the value of adding biceps rerouting to a forearm osteotomy in the presence of severe supination deformity to prevent recurrences, but patient data on these combined procedures have not been published and no conclusions could be made. 7,15 Several studies have shown that a successful forearm osteotomy without recurrence may result in a postoperative passive pronation between 46 and 70 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…Biceps rerouting alone may be used in mild cases with almost normal passive forearm rotation but absence of active pronation. 6 In severe cases, with a passive pronation deficit, forearm osteotomy is indicated, but recurrence rates are reported to be 20 to 40%, due to muscle imbalances across the forearm. We therefore hypothesized that in cases with a decrease in pronation in the first postoperative months after forearm osteotomy, a biceps rerouting is indicated to prevent recurrence.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

2017

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

2017

View full text Add to dashboard Cite

show abstract

“…27 Most commonly, a supination deformity can be treated by rerouting the direction of biceps pull. 42 On rare occasions, supinator release is required.…”

Section: Spastic Supinationmentioning

confidence: 99%

“…The repair must be protected with a long-arm cast for 4 to 6 weeks, with the forearm resting in neutral rotation. 38,42…”

Section: Technique Of Biceps Reroutingmentioning

confidence: 99%

Spastic Paralysis of the Elbow and Forearm

Gharbaoui

Kania

Cole

2016

Seminars in Plastic Surgery

View full text Add to dashboard Cite

).Spasticity presents as muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motor neuron syndrome. 1,2 Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, pediatricians, orthopaedic surgeons, and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). 2,3 The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, flexion of the wrist with ulnar deviation, and the deformity of the fingers (flexion contracture, swan-neck, and thumbs-in-palm). [4][5][6] The primary objectives in these patients will be to improve communication with their surroundings, to perform activities of daily living, and to increase mobility and walking. Control of Spasticity Nonsurgical Management OptionsThe treatment of spasticity is highly dependent on the time since injury and the prognosis for recovery. In the period of neurologic recovery, temporizing interventions are most appropriate because permanent changes may result in the chronic imbalance of forces across joints. The prevention of additional complications, such as disuse muscle atrophy, joint contractures, heterotopic ossification, and peripheral neuropathies, is critical in optimizing functional outcome. 2,4,7 Several treatment choices are available, including cast and splint use, oral drug therapy, intrathecal baclofen, chemodenervation, neurolytic blocks, phenol blocks, and botulinum toxin (BoNT) blocks. 2,6,7 Cast and Splint UseIn addition to a variety of medical regimens to be discussed, various casting or splinting techniques can provide temporary relief of spasticity. Casting helps maintain muscle fiber length and diminishes muscle tone by decreasing sensory input and providing a structural impediment to spastic contracture. Changed on a weekly basis, serial casts can be used to correct joint contractures and is successful for contractures present < 6 months. Although there is some effect on spasticity, this is generally not a practical treatment modality. Dynamic splinting has a very limited role in treating spastic contractures and may even exacerbate the situation by triggering increased muscle tone. Both dynamic splints and serial casting may be very helpful after surgical release to correct the residual static component. As an adjunct, local anesthetic nerve blocks are helpful prior to cast application as they relieve spasticity and improve limb positioning. [6][7][8][9] Oral Drug Therapy Several oral antispastic agents may be used during this period; however, it is critical to understand the strengths Keywords ► spasticity ► hypertonia ► cerebral palsy ► nonsurgical treatment ► surgical treatment AbstractAs the physiologic ...

show abstract

Brachial Plexus Birth Injury: Late Complications and Treatment (Shoulder, Forearm, and Hand)

Hems

2021

Operative Brachial Plexus Surgery

View full text Add to dashboard Cite

Treatment of Supination Deformity for Obstetric Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 31 publications

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

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

Spastic Paralysis of the Elbow and Forearm

Brachial Plexus Birth Injury: Late Complications and Treatment (Shoulder, Forearm, and Hand)

Contact Info

Product

Resources

About