Akademik Veri Yönetim Sistemi
XVI FESSH CONGRESS, Oslo, Norveç, 26 - 28 Mayıs 2011, ss.34
Purpose: Obstetrical palsy of the upper extremity repre-
sents a severe traumatic complication, which involves the
brachial plexus and occasionally the osteoarticular struc-
tures and muscles of the shoulder. Our aim is to describe
and find an adequate modality of treatment for the rela-
tively frequent obstetrical palsy sequela presented as fore-
arm supination deformity. Forearm supination deformity
tends to be progressive and therefore early recognition of
this deformity is of paramount importance to prevent fixed
deformities, which increase the hand function deficit.
Forearm supination deformity is classified in two stages:
flexible (posture in supination) and fixed (contracture)
deformity, which directly determine the choice of the oper-
ative procedure(s). When passive reduction of the supina-
tion deformity is possible (flexible deformity) soft tissue
procedures including tendon transfers are indicated. The
bony procedures should be preferred in cases with severe
contracture of the forearm in supination and distal radio-
ulnar joint luxation (fixed deformity). In this study we used
soft tissue techniques (including biceps re-routing
pronotoplasty, brachioradialis re-routing pronotoplasty
with or without interosseous membrane release) and tech-
niques which include osteotomy of the forearm bones (ex-
cision of the radial head, radius pronation osteotomy, distal
radio-ulnar fusion and wrist arthrodesis) to restore fore-
arm posture and wrist stability in patients with supination
deformity secondary to brachial plexus birth palsy.
Methods: Forty-three children (27 male, 16 female) whose
age ranged between 3 and 15 years (mean age 8.2) oper-
ated between 1998 and 2004 were included in this study.
Eighteen of them (11 male, 7 female) underwent soft tissue
procedures, while twenty-five (16 male, 9 female) had
osteotomy.
Results: As soft tissue procedures, the selected tech-
niques were biceps re-routing pronotoplasty for 4 children and brachioradialis re-routing pronotoplasty for 14 of
them. Average gain in active pronation was 82.5 degrees,
average loss of active supination was 22.5 degrees and
average gain in total active motion was 55 degrees for
the biceps re-routing group, whereas average gain in
active pronation was 63.5 degrees, average loss of active
supination was 11 degrees and average gain in total active
motion was 53.2 degrees in brachioradialis re-routing
group. Selected techniques were excision of the radial
head for 4 patients, radius pronation osteotomy for 6
patients, distal radio-ulnar fusion for 4 patients and wrist
arthrodesis for 4 patients as the osteotomy procedures.
Average gain in active pronation was 96 degrees in radius
head excision, 66 degrees in radius pronation osteotomy,
61 degrees in distal radio-ulnar fusion and 58 degrees in
wrist arthrodesis groups. For the osteotomy group as a
whole, the mean active forearm supination decreased
from 50.4 degrees preoperatively to 40.8 degrees after sur-
gery. More than one procedure (mostly 2-3) were often
necessary to achive the desired results.
Conclusions: These results clearly show that patients can
benefit from surgical correction of forearm supination
deformity which probably will cause significant improve-
ment in functional status. After these surgical procedures,
in a considerable proportion of patients, the "begging hand"
posture can be corrected to a more functional and less
noticeable position. Key words: Obstetric palsy, brachial
plexus, supination deformity, osteotomy, brachioradialis
re-routing pronotoplasty.