Secondary Surgery, Forearm

Reinnervation, Hand Function

Biceps Rerouting

Another example of muscular unbalance that needs a surgical correction is the supinated forearm; the hand shows the palm upward and is unable to rotate with the palm downward as it is normally necessary for everyday life movements. This useless and unaesthetic position of the hand can be solved by means of a palliative operation that through a rerouted of the tendon of the biceps muscle transforms it into a pronator of the forearm, therefore allowing the hand to turn the palm downward.

The tendon of biceps muscle is divided in Z-way in order to obtain a long strip of tendon still attached to the radius. The tendon is then re-rooted along the head of the radius passing through the interosseous membrane producing in this way a pronation of the forearm and fixed with tension to the proximal part of the biceps. In this way the physiological supinating action of the biceps is trasformed into a pronated one.

1. Typical supinated deformity of the forearm in a severe total paralysis. There is an indication of rerooting of the biceps either for a functional purpose and aesthetic one
2. Functional and aesthetic result with a forearm pronated with the flexion of the elbow.

Rotation Osteotomy

For the supinated hand , it is not possible to do any soft-tissue procedure when the supination is fixed . In those cases , the only possibility will be an osteotomy of the Radius .
The incision is made on the lateral distal forearm , over the radius . The lower third of the bone is exposed and the osteotomy done with a saw . The forearm is rotated 90 to 100° in order to obtain a supination of 45° .

The bone is fixed with a plate and screws . Immobilization with a plaster is maintained for 6 weeks and the removed . The child is left free avoiding prosupination movements until the bone is healed , usually at 3 months .