Pronating osteotomy of the radius for forearm supination contracture in high-level tetraplegic patients: technique and results.
We report the results of performing a pronating osteotomy of the radius, coupled with other soft-tissue procedures, as part of an upper limb functional surgery programme in tetraplegic patients with supination contractures. In total 12 patients were reviewed with a mean follow-up period of 60 months (12 to 109). Pre-operatively, passive movement ranged from a mean of 19.2 degrees pronation (-70 degrees to 80 degrees ) to 95.8 degrees supination (80 degrees to 140 degrees ). A pronating osteotomy of the radius was then performed with release of the interosseous membrane. Extension of the elbow was restored postoperatively in 11 patients, with key-pinch reconstruction in nine. At the final follow-up every patient could stabilise their hand in pronation, with a mean active range of movement of 79.6 degrees (60 degrees to 90 degrees ) in pronation and 50.4 degrees (0 degrees to 90 degrees ) in supination. No complications were observed. The mean strength of extension of the elbow was 2.7 (2 to 3) MRC grading. Pronating osteotomy stabilises the hand in pronation while preserving supination, if a complete release of the interosseous membrane is also performed. This technique fits well into surgical programmes for enhancing upper limb function.
Lapeyronie University Hospital, Montpellier, France. bertrand-coulet@wanadoo.fr
B
B
Coulet
J G
JG
Boretto
Y
Y
Allieu
C
C
Fattal
I
I
Laffont
M
M
Chammas
D000203:Activities of Daily Living; D000328:Adult; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods* / Q000534:rehabilitation; D011403:Pronation; D011782:Quadriplegia / Q000150:complications* / Q000503:physiopathology; D011884:Radius / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013484:Supination; D014955:Wrist Joint / Q000503:physiopathology; D055815:Young Adult