Corrective Osteotomies of the Radius and Ulna for Supination Contracture of the Pediatric and Adolescent Forearm Secondary to Neurologic Injury

PurposeTo present the authors’ experience with internal fixation of the radius and ulna as a surgical option for correction of supination contracture of the forearm.MethodsTwelve patients (13 limbs) had an osteotomy of the radius and ulna for a supination deformity secondary to a residual brachial plexus or spinal cord injury. Surgery consisted of proximal ulna and distal radius osteotomies combined with plate fixation.ResultsThe average age of the patients at the time of surgery was 11 years. Five limbs had fixed supination deformities and 8 limbs lacked pronation beyond neutral. The average preoperative supination deformity (either fixed or measured at midarc) was 76°. The average intraoperative correction was 86°. The average follow-up period was 16 months. The average midrange resting position maintained at final follow-up evaluation was 2° of pronation. All limbs ultimately obtained radiographic and clinical union of the osteotomy sites. Complications included 6 plate fractures; however, only 1 patient required revision internal fixation.ConclusionsThe combination of a proximal ulna and distal radius osteotomy with internal fixation can provide excellent correction, but the implant must be strong enough to hold the osteotomies rigidly in the corrected position during the time needed for union.Type of study/level of evidenceTherapeutic, Level IV.