Restoration of Forearm Supination Deformity in Brachial Plexus Birth Palsy

Aim: Forearm supination deformity is a serious sequela of brachial plexus birth palsy(BPBP) that affects
both functionality and apperance. In the early phase, soft tissue procedures are preferred whereas bone
procedures are preferred in the late phase. In this study, the techniques of forearm supination deformity
restoration and their results were evaluated.
Patients and Methods: Forty three children (mean age of 8.2 years) were included in the study. Eighteen
patients had soft tissue procedures and 25 patients had bone procedures. For soft tissue procedures, 14
patients had bracioradialis re-routing pronatorplasty and 4 patients had biceps re-routing procedures. For
bone procedures, 10 patients had radius rotation osteotomies, 11 patients had radial head excisions and
9 patients had distal radio-ulnar synostosis. Preoperative and postoperative active and passive forearm
supination and pronation degrees were measured goniometrically .
Results: The mean preoperative and postoperative active pronation degrees for brachioradialis re-routing
pronatorplasty and biceps re-routing changed from -32.8° to 30.7° and from -40° to 42.5° respectively.
The mean preoperative and postoperative active pronation degrees for radius rotation osteotomy, radial
head excision and distal radio-ulnar synostosis changed from -70° to -4° and from -53° to 43° and -80°
to -19° respectively .
Conclusion: Satisfactory functional and postural improvements may be obtained with palliative surgeries
that involve either the soft tissue or the bone in the setting of forearm supination deformities that are late
sequelae of BPBP.