Rojas-Neira Juliana, Chaves Camilo, Díaz-Gallardo Paula, Nguyen Trong-Quynh, Dominguez-Amador Juan J, Soldado Francisco
Hand Surgery and Microsurgery Department, Pontificial Javeriana University, Cali, Colombia.
Institut de la Main Nantes Atlantique Saint Herblain, France.
J Child Orthop. 2024 Sep 28;18(5):540-545. doi: 10.1177/18632521241276348. eCollection 2024 Oct.
The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°.
In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique.
The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications.
Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities.
IV.
单骨前臂手术被认为是治疗严重前臂畸形的一种潜在方法。然而，其主要局限性在于骨不连和感染风险升高。为了提高愈合率，引入了一种技术改良，不仅要建立桡尺骨端对端固定，还要在桡骨近端和远端截骨残端之间增加一层覆盖和固定。该技术最初应用于包括神经、肿瘤和先天性疾病患者在内的异质性患者群体，取得了令人满意的结果，骨愈合率达到100%，旋后矫正可达120°。
在本研究中，我们回顾性分析了28例平均年龄为9岁的患者队列，这些患者均因新生儿臂丛神经损伤导致前臂旋后挛缩超过90°。这些患者接受了改良技术治疗。
前臂旋转的平均矫正角度为116°，平均随访期延长至43个月。值得注意的是，所有患者平均在6.6周内均实现了骨愈合，且无任何并发症。
我们的研究结果强调了这种改良技术的有效性，该技术能够实现显著的旋转矫正，骨愈合率高，并发症发生率低。这种方法对于患有严重固定旋后畸形的新生儿臂丛神经损伤的年轻患者尤为有价值。
IV级。
