[Brachioradialis rerouting for restoration of forearm supination or pronation].
OBJECTIVE
Improvement of active forearm supination or pronation. Reduction of paralytic pronation or supination posture.


METHODS
Disability or impairment of active supination or pronation due to cerebral palsy, obstetric palsy or traumatic brachial plexus palsy, quadriplegia or paralysis from other causes.


METHODS
Inadequate passive range of motion of forearm supination or pronation. Insufficient power of brachioradialis muscle < M4. Insufficient rehabilitation after conservative treatment or neurosurgical intervention with possible improvement of supination or pronation. Lack of patient's cooperation and compliance.


METHODS
Exposure and mobilisation of brachioradialis muscle. Division of brachioradialis tendon distally with Z-plasty. Passing distal tendon through the interosseus space in dorsal to palmar direction for restoration of supination respectively in palmar to dorsal direction for restoration of pronation. Suturing both tendon ends.


METHODS
Management includes an above elbow cast with the elbow in 70° flexion for 4 weeks. Then active physiotherapy to learn new brachioradialis muscle function for supination or pronation over 1-1.5 years. If needed dynamic orthesis.


RESULTS
Özkan et al. performed brachioradialis rerouting to restore supination in 5 children between 4 and 14 years with pronation deformity and to restore pronation in 4 children aged 5-9 years with supination deformity. Mean active gain for supination was 81° (40-140°). Active pronation improved from 28 to 49° (30-75°; Özkan et al., J Hand Surg Br 29:263-268, 2004; Özkan et al., J Hand Surg Am 29:22-27, 2004). Between April 2006 and January 2011 we used this technique in 4 patients aged 7-26 years (mean 14 years). Three patients could be followed up. One patient had preoperative a fixed pronation deformity of the forearm in 80° pronation. In this case active range of motion could be improved to 80/30/0° pronation/supination. One patient improved from preoperative 0/0/90° pronation/supination to 30/0/90° postoperatively. In one case no functional improvement of forearm rotation could be achieved in long-term follow-up. No functional loss in forearm rotation to the opposite direction or of the elbow function was observed. Mean follow-up time was 51 months (21-77 months).
Klinik für Handchirurgie, Herz- und Gefäß-Klinik GmbH, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland. yoko.gugger@handchirurgie.de
Y
Y
Gugger
K-H
KH
Kalb
K-J
KJ
Prommersberger
J
J
van Schoonhoven
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005542:Forearm / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D009069:Movement Disorders / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D013709:Tendon Transfer / Q000295:instrumentation / Q000379:methods*; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult