Rotatory contracture of the forearm.

We saw seven patients with an idiopathic progressive loss of rotation of the forearm, occurring primarily during adolescence and manifested principally by a gradual loss of supination. There were secondary developmental abnormalities of the radial head and of the ulna (distal bowing) in four patients. Six surgical procedures were performed on five of the seven patients, consisting of combinations of sectioning of the quadrate ligament, release of the interosseous membrane, and ostecotomy and compression-plate fixation of the distal end of the ulna. There was functional improvement in four patients. Release of the quadrate ligament provided the greatest improvement, but that release alone was of minimum value. We concluded that a contracted quadrate ligament may be an important deterrent to supination of the forearm, but distortion of the radial head, curvature of the ulna, and contracted soft tissues in the interosseus space and distal radio-ulnar joint also are contributory factors.