One-bone Forearm for the Treatment of Supination Contractures Secondary to Neonatal Brachial Plexus Injury

Overview

Journal J Child Orthop

Publisher Sage Publications

Specialty Pediatrics

Date 2024 Oct 11

PMID 39391577

Authors

Juliana Rojas-Neira

Camilo Chaves

Paula Diaz-Gallardo

Trong-Quynh Nguyen

Juan J Dominguez-Amador

Francisco Soldado

Affiliations

Soon will be listed here.

Abstract

Background: The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°.

Methods: In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique.

Results: The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications.

Conclusion: Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities.

Case Series Level Of Evidence: IV.

References

Allende C, Gilbert A . Forearm supination deformity after obstetric paralysis. Clin Orthop Relat Res. 2004; (426):206-11. DOI: 10.1097/01.blo.0000141900.85203.ce. View

Kim S, Chim H, Bishop A, Shin A . Complications and Outcomes of One-Bone Forearm Reconstruction. Hand (N Y). 2017; 12(2):140-144. PMC: 5349412. DOI: 10.1177/1558944716643305. View

Hutchinson D, Wang A, Ryssman D, Brown N . Both-bone forearm osteotomy for supination contracture: a cadaver model. J Hand Surg Am. 2006; 31(6):968-72. DOI: 10.1016/j.jhsa.2006.01.010. View

Morrey B, Askew L, Chao E . A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981; 63(6):872-7. View

ZANCOLLI E . Paralytic supination contracture of the forearm. J Bone Joint Surg Am. 1967; 49(7):1275-84. View

Peterson 2nd C, Maki S, Wood M . Clinical results of the one-bone forearm. J Hand Surg Am. 1995; 20(4):609-18. DOI: 10.1016/S0363-5023(05)80277-1. View

Magermans D, Chadwick E, Veeger H, van der Helm F . Requirements for upper extremity motions during activities of daily living. Clin Biomech (Bristol). 2005; 20(6):591-9. DOI: 10.1016/j.clinbiomech.2005.02.006. View

Jacoby S, Bachoura A, DiPrinzio E, Culp R, Osterman A . Complications following one-bone forearm surgery for posttraumatic forearm and distal radioulnar joint instability. J Hand Surg Am. 2013; 38(5):976-982.e1. DOI: 10.1016/j.jhsa.2013.02.005. View

Chan P, Blazer P, Bozentka D, Gonzalez J, Naranja R, Roros B . Optimal position for the one-bone forearm. An analysis using a hinged brace in normal subjects. J Hand Surg Br. 2000; 24(6):724-6. DOI: 10.1054/jhsb.1999.0258. View

10.

Gellman H, Kan D, Waters R, Nicosa A . Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma. J Bone Joint Surg Am. 1994; 76(3):398-402. DOI: 10.2106/00004623-199403000-00010. View

11.

Chen F, Culp R, Schneider L, Osterman A . Revision of the ununited one-bone forearm. J Hand Surg Am. 1998; 23(6):1091-6. DOI: 10.1016/S0363-5023(98)80021-X. View

12.

Waters . Obstetric Brachial Plexus Injuries: Evaluation and Management. J Am Acad Orthop Surg. 1997; 5(4):205-214. DOI: 10.5435/00124635-199707000-00004. View

13.

Ruhmann O, Hierner R . [Z-plasty and rerouting of the biceps tendon with interosseous membrane release to restore pronation in paralytic supination posture and contracture of the forearm]. Oper Orthop Traumatol. 2009; 21(2):157-69. DOI: 10.1007/s00064-009-1703-x. View

14.

Wang A, Stubin-Amelio L, Athanasian E . Selection of fusion position during forearm arthrodesis. J Hand Surg Am. 2000; 25(5):842-8. DOI: 10.1053/jhsu.2000.9417. View

15.

Schachinger F, Pobatschnig B, Kranzl A, Stauffer A, Farr S . Outcomes of patients with single-bone-forearm surgery: a clinical assessment and three-dimensional motion analysis. J Hand Surg Eur Vol. 2019; 44(8):838-844. DOI: 10.1177/1753193419852609. View

16.

Wang A, Hutchinson D, Coleman D . One-bone forearm fusion for pediatric supination contracture due to neurologic deficit. J Hand Surg Am. 2001; 26(4):611-6. DOI: 10.1053/jhsu.2001.26175. View

17.

Hankins S, Bezwada H, Kozin S . Corrective osteotomies of the radius and ulna for supination contracture of the pediatric and adolescent forearm secondary to neurologic injury. J Hand Surg Am. 2006; 31(1):118-24. DOI: 10.1016/j.jhsa.2005.08.011. View

18.

Clippinger B, Plucknette B, Soldado F, Turvey B, Barrera-Ochoa S, Kozin S . The One-Bone Forearm in Children: Surgical Technique and a Retrospective Review of Outcomes. J Hand Surg Am. 2021; 47(2):189.e1-189.e9. DOI: 10.1016/j.jhsa.2021.04.009. View

19.

Wang K, Vuillermin C, Waters P . Single-Bone Forearm as a Salvage Procedure in Recalcitrant Pediatric Forearm Pathologies. J Hand Surg Am. 2020; 45(10):947-956. DOI: 10.1016/j.jhsa.2020.05.007. View

20.

Bahm J, Gilbert A . Surgical correction of supination deformity in children with obstetric brachial plexus palsy. J Hand Surg Br. 2002; 27(1):20-3. DOI: 10.1054/jhsb.2001.0647. View