Surgical correction of supination deformity in children with obstetric brachial plexus palsy

We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78degrees the immediate postoperative position was 29degrees pronation and it stabilized at follow-up at 17degrees pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22degrees pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the "begging hand" to be corrected to a more functional and less noticeable position.