The Pronating Radius Osteotomy for Correcting the Supination Deformity in Brachial Plexus Birth Palsy

Abstract

Objective: Severe supination deformity may be seen in brachial plexus birth palsy (BPBP). The aim of this study was to determine the efficacy of pronating radius osteotomy in the management of this deformity.Material and Methods: BPBP patients with severe supination deformity were included in this study and they were operated between November 2003 and December 2015, by the same operative team. Pronating radius osteotomy was performed and internal fixation was maintained either by Kirschner wires or semitubular plates. In some patients, tendon transfers were performed during the same operation for the restoration of shoulder and thumb abduction and wrist extension.Results: Forty one patients had supination deformities caused by BPBP. The mean age was 9.2 years (4-22). The mean follow-up was 5 years (1-7). The mean active pronation was -60° before the operation, and the passive one was -10°. The mean active pronation of the patients was 9° after the operation, and the passive one was 45°. The mean active supination of the patients was 75° before the operation, and the passive one was 85°. The mean active supination of the patients was 45° after the operation,and the passive one was 65°. One malunion was detected at the second year after the operation (1/41). Three patients had low pronation degrees during the follow-up (3/41).Conclusion: Satisfactory postural and functional improvement can be achieved with the use of pronating radius osteotomy for patients with severe supination contractures.