Wieneke P Metsaars1, Jan Ferdinand Henseler2, Jochem Nagels2, Rob G Nelissen2. 1. Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: wmetsaars@gmail.com. 2. Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands.
Abstract
PURPOSE: Forearm osteotomy for supination deformity in brachial plexus birth palsy (BPBP) may lead to improved function of the upper limb. However, recurrence rates are high and limit satisfactory results. METHODS: We reviewed the long-term outcome of the entire upper limb of 22 BPBP patients with a supination contracture who were treated by forearm osteotomy and compared them with an age-matched group that was treated nonsurgically (n = 28). Recurrence was defined as a passive pronation below 30°. RESULTS: The median follow-up was 5.0 years (range, 1.5-14 years). The mean passive pronation after forearm osteotomy, including patients with recurrence at follow-up, improved from -1° (SD, 9°) to 33° (SD, 48°) at final follow-up, mean active wrist extension improved from 23° (SD, 40°) to 41° (SD, 38°). An overall improvement of wrist and hand strength was present. In patients without recurrence, pronation improved to a mean of 66° (SD, 23°) at final follow-up. Recurrence of the supination contracture was present in 9 cases (41%) and was only present in patients with a single bone osteotomy. Recurrence was associated with lower age at surgery (recurrence mean, 4 [SD, 1.2] and no recurrence 8 [SD 4.5]), lower shoulder external rotation (recurrence mean, 28 [SD, 17] and no recurrence 49 [SD, 23]), and overall lower hand function at baseline. CONCLUSIONS: Forearm osteotomy improves forearm pronation and hand function. Recurrence should be considered as a potential complication after forearm osteotomy and is associated with young age and lower function of shoulder and hand. Single-bone osteotomy might also be a risk factor for recurrence. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: Forearm osteotomy for supination deformity in brachial plexus birth palsy (BPBP) may lead to improved function of the upper limb. However, recurrence rates are high and limit satisfactory results. METHODS: We reviewed the long-term outcome of the entire upper limb of 22 BPBP patients with a supination contracture who were treated by forearm osteotomy and compared them with an age-matched group that was treated nonsurgically (n = 28). Recurrence was defined as a passive pronation below 30°. RESULTS: The median follow-up was 5.0 years (range, 1.5-14 years). The mean passive pronation after forearm osteotomy, including patients with recurrence at follow-up, improved from -1° (SD, 9°) to 33° (SD, 48°) at final follow-up, mean active wrist extension improved from 23° (SD, 40°) to 41° (SD, 38°). An overall improvement of wrist and hand strength was present. In patients without recurrence, pronation improved to a mean of 66° (SD, 23°) at final follow-up. Recurrence of the supination contracture was present in 9 cases (41%) and was only present in patients with a single bone osteotomy. Recurrence was associated with lower age at surgery (recurrence mean, 4 [SD, 1.2] and no recurrence 8 [SD 4.5]), lower shoulder external rotation (recurrence mean, 28 [SD, 17] and no recurrence 49 [SD, 23]), and overall lower hand function at baseline. CONCLUSIONS: Forearm osteotomy improves forearm pronation and hand function. Recurrence should be considered as a potential complication after forearm osteotomy and is associated with young age and lower function of shoulder and hand. Single-bone osteotomy might also be a risk factor for recurrence. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.