Purpose
Forearm supination contractures occur in 7% of children with brachial plexus birth
injuries (BPBI). Biceps rerouting is proposed when pronation has deteriorated but
is passively correctable to at least 0° (neutral). The purpose of this investigation
was to evaluate long-term outcomes of biceps rerouting for this indication, including
magnitude and maintenance of correction, complications, and subsequent osteotomy.
Methods
We conducted a retrospective review of all children with BPBI and forearm supination
contractures treated with biceps rerouting alone, for the above indications, from
1993 to 2017 with at least 2 years follow-up. Demographic information, BPBI characteristics,
surgical details, and ranges of motion were obtained from medical records. Pre- and
postoperative active pronation (AP) and supination (AS), elbow flexion contracture,
and arc of forearm rotation (Arc) were analyzed using linear mixed-effect models.
Results
Twenty-five children (13 females; 13 left forearms; 15 global BPBI) underwent biceps
rerouting at age 7 ± 3 years and were followed for 6 ± 3 years. Before surgery, the
mean AP and AS were 6° ± 29° and 62° ± 27°, respectively. At the final follow-up,
the mean AP, AS, and Arc were 39° ± 36°, 18° ± 34°, and 57° ± 42°, respectively. AP
was significantly improved and AS was significantly decreased by 2 years after surgery
and at the final follow-up. Neither Arc nor elbow flexion contracture changed significantly.
Two of 25 (8%) children underwent subsequent forearm osteotomy.
Conclusions
Biceps rerouting in children with BPBI improves the forearm position when pronation
is deteriorating by shifting the arc from supination to pronation without decreasing
the arc of motion or worsening elbow flexion contractures. There is a low risk of
complications and a limited need for subsequent forearm osteotomy. These results are
maintained over time. When performed before passive pronation is reduced beyond neutral,
this procedure may prevent severe supination contractures and reduce the need for
forearm osteotomy.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: December 22, 2021
Accepted:
October 13,
2021
Received:
January 25,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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