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Corrective Osteotomies and Osteosynthesis for Supination Contracture of the Forearm in Children

Rolfe, Kevin W. MD, MPH*; Green, Terri A. BS; Lawrence, John F. MD

Journal of Pediatric Orthopaedics: June 2009 - Volume 29 - Issue 4 - p 406-410
doi: 10.1097/BPO.0b013e3181a6bf90
Upper Extremity: Original Article

Purpose: The purpose of this study was to present the authors' experience with corrective osteotomies of the forearm for supination contracture in children.

Methods: Fourteen patients with supination contracture of the forearm due to brachial plexus lesion (11), poliomyelitis residuals (2), or Monteggia fracture malunion (1) underwent distal ulnar osteotomy without fixation and subsequent midradial osteotomy with plate fixation to produce a position of greater pronation. A minimum of 6 months' follow-up was required to be included in the series.

Results: Ten boys and 4 girls whose mean age was 11 years underwent surgery between 1998 and 2006 to correct a supination contracture. The mean preoperative contracture measured 80 degrees of supination. The final mean postoperative correction was 104 degrees, whereas the final mean position of pronation was 24 degrees.

Conclusions: Distal ulnar and midradial osteotomies are effective in the treatment of supination deformities of the forearm with little risk of complication or need for additional surgery. Radial fixation is important, but ulnar fixation is not required. Both osteotomies must be complete before plate fixation of the radius to realize maximal correction.

Level of Evidence: Level IV.

From the *Kaiser Oakland Medical Center, Oakland; and †Shriners Hospitals for Children, Oakland, CA.

None of the authors received financial support for this study.

Reprints: John F. Lawrence, MD, Shriners Hospitals for Children, 3160 Geneva St, Los Angeles, CA 90020. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.