Author/Authors :
melhem, elias saint joseph university (usj) - faculty of medicine, Beirut, Lebanon , rizkallah, maroun saint joseph university (usj) - faculty of medicine, Beirut, Lebanon , el rayess, johnny saint joseph university (usj) - faculty of medicine, Beirut, Lebanon , sassine, serge saint joseph university (usj) - faculty of medicine, Beirut, Lebanon , ghanem, ismat saint joseph university (usj) - faculty of medicine, hôtel-dieu de france university hospital - department of orthopedic surgery, Beirut, Lebanon
Abstract :
Introduction: Supination contracture in patients with obstetrical brachial plexus paralysis (OBPP) results in severe functional limitation of daily activities. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not yet been clearly defined. Material and methods: This is a retrospective chart review of children with OBPP who underwent a pronating forearm osteotomy for their supination contracture at our institution between 2007 and 2014. Patients were evaluated for resting forearm position, forearm passive and active pronation and supination, preoperatively and at their last followup. Age correlation to outcomes was also tested. A subjective assessment tool for improvement was also used to evaluate patient-oriented outcomes. Results : Eighteen patients with a mean age of 8.5 years (3.7-17) and a mean follow-up of 55 months (24-100) were included. Preoperatively, patients had a forearm resting position of - 90°. Mean passive pronation was -45° (-30° to -60°). All patients had no active pronation. At their last follow-up, mean forearm resting position was - 4° (- 45° to +10°; p 0.001), mean active pronation was +26° (0° to +60°; p 0.001), mean passive pronation reached + 76° (+ 50° to + 90°; p 0.001), mean active supination was - 37° (- 50° to - 25°; (p 0.001) and mean passive supination was - 80° (- 90° to - 73°; p 0.001). There were no correlation between age at surgery and final outcomes. Subjective self-assessment tool showed a mean partial improvement in all five tested headings. Discussion: Pronation osteotomy in OBPP patients with supination contracture is an effective reliable procedure with reproducible results. It seems to be associated with partially improved functional results in the postoperative period. While recurrence is possible, age at surgical intervention does not seem to affect the final outcome
NaturalLanguageKeyword :
obstetrical brachial plexus palsy , supination contracture , pronation osteotomy , functional improvement
