title: Treatment of supination deformity for obstetric brachial plexus injury: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis of the literature evaluating treatment outcome for supination deformity in obstetric brachial plexus injury.
  
  
  METHODS
  We included studies on brachial plexus and supination deformity with follow-up of at least one year and quantitative measurements of forearm mean passive pronation and position at rest. Meta-analysis was used to explore modifying factors.
  
  
  RESULTS
  An elaborate search strategy resulted in 366 studies, of which 13 were included totaling 238 patients (157 osteotomies and 71 biceps rerouting). There was a 75° gain in position at rest and a 65° gain in passive pronation for the osteotomy group, compared to a 79° gain in position at rest for the biceps rerouting group. More severe deformities had greater gains. No influence of age was found. Important adverse effects were hardware failure and a biceps rupture. Recurrence in the osteotomy group was 20% to 40%, versus none in the soft-tissue group.
  
  
  CONCLUSIONS
  This review showed an overall benefit for forearm osteotomies and for biceps rerouting for supination deformity with the gain proportionate to the severity of the deformity.
  
  
  METHODS
  Therapeutic III.
authors: Department of Orthopaedics and Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: w.p.metsaars@lumc.nl.
authors: W P
authors: WP
authors: Metsaars
authors: Department of Orthopaedics and Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
authors: J
authors: J
authors: Nagels
authors: Department of Orthopaedics and Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
authors: B G
authors: BG
authors: Pijls
authors: Department of Orthopaedics and Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
authors: J M
authors: JM
authors: Langenhoff
authors: Department of Orthopaedics and Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
authors: R G H H
authors: RG
authors: Nelissen
mesh_terms: D001720:Birth Injuries / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D006801:Humans; D018482:Muscle, Skeletal / Q000601:surgery; D010027:Osteotomy; D013484:Supination; D038062:Upper Extremity Deformities, Congenital / Q000601:surgery*
keywords: Plexus brachialis; biceps rerouting; obstetric palsy; osteotomy; supination deformity