Clinical Example: Ulna Rotation Osteotomy for Correction of Forearm Pronation Contracture

Pronation contracture of the forearm limits  hand-face contact, perineal self care and other activities. There are many etiologies, traumatic more common than congenital. Both soft tissue (contracture of interosseous membrane and pronator muscles, PRUJ and DRUJ capsular contractures) and skeletal (rotatory malunion) may be responsible, and correction may require both soft tissue release and skeletal repositioning. This case demonstrates ulna supination osteotomy as an adjunct to soft tissue release to manage  forearm pronation contracture following distal radius fracture malunion.
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This patient sustained a closed distal radius fracture treated in another country.
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Initial treatment was closed reduction and casting. 18 months later, she presented with loss of forearm supination past neutral and ulnar head prominence and pain.
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After release of both pronators from the radius and release of the distal half of the interosseous membrane, passive supination was unchanged. A 60 degree ulnar supination and  2 mm shortening osteotomy was performed, with nearly 60 degrees improvement of supination intraoperatively.
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Ulnar styloid position on a forearm AP radiograph demonstrates the degree of rotation
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Uneventful healing. Final supination was 45 degrees.
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