Evaluation of supination deformity in residual plexus brachialis injury

Rationale: Supination deformity is estimated to be present in 6-10 % of
children with residual plexus brachialis birth injury. Several types of
operative correction have been described in literature. In our hospital
mid-distal radiusosteotomy and/or proximal ulna osteotomy have been performed
in cases of supination contracture. For active pronation deficit without true
contracture, Zancolli biceps rerouting was performed. In forearm osteotomies a
recurrence rate as high as 20-40 % is reported in literature, possibly due to
persistent supination forces and growth. In this project we will evaluate the
longterm results and the potential (dis)advantages of forearm osteotomies and
bicepsrerouting. Our hypothesis is that at follow-up, the Range of Motion (RoM)
will be increased in all patients versus the pre-operative status.

The primary goal of this study is to evaluate the clinical long term results of
patients with a forearm osteotomy and/or soft-tissue procedures to correct a
supination deformity. Furthermore we will try to identify association between
functional outcome and age at intervention, preoperative malletscore and
shoulder, elbow and hand function, in an attempt to be able to optimize
selection of patients for operative procedures.
Secondary goals are to compare preoperative MRI muscle quality scores in
patients with supination deformity compared to a matched patient group with
residual plexus injury without supination deformity.

Retrospective cohort study with historical patient groups: mid-distal radius
osteotomy alone, ulna osteotomy alone, both bone forearm osteotomy and biceps
rerouting. Control group of patients with a supination deformity who did not
receive surgical intervention. Preoperative MRI scan of the elbow of these
patients with supination deformity, compared to a Narakas classification and
age matched control group of elbow MRI-scans of plexus brachialis patients
without a supination deformity.

The potential risk associated with this study is negligible. Patients included
in this study will reveive the same care as all other patients.