Forearm supination deformity after obstetric paralysis.

We retrospectively evaluated 66 patients who had radius osteotomies (44 patients; average age, 79.9 months) or soft tissue procedures (22 patients; average age, 57.4 months) to improve persistent supination at rest secondary to obstetric brachial plexus lesions and select the optimal treatment indication for each patient. Followups averaged 64.3 months and 72.57 months, respectively. In the osteotomy group there was a significant difference when preoperative supination at rest (average 31 degrees), intraoperative pronation obtained (average 114 degrees), and position of the forearm at last followup (average 92 degrees), were compared, whereas in the soft tissue procedures group there was not a significant difference between intraoperative pronation obtained (average 116 degrees) and forearm position at rest at last followup (average 108 degrees). Shoulder function was not affected by any of these interventions. Elbow extension was decreased at the last followup in both groups. Wrist and finger extension were improved in both groups. Complications included two delayed unions, one nonunion, and nine recurrences, all secondary to radius osteotomies. The procedure of choice for each patient must be based on preoperative forearm motion, condition of the proximal and distal radioulnar joints, triceps function, deformities of the shoulder and elbow, and hand function.