Technique: oblique radial osteotomy for supination syndrome

Supination syndrome is a relatively common upper-extremity deformity in patients with incomplete recovery after severe brachial plexus injuries. It is a highly disabling condition because of the awkward positioning of the forearm and, hence, the hand. Historically, one surgical option has been to transfer the distal tendon of the biceps brachii muscle. However, the efficacy of this procedure often may be limited because of contractures of the interosseous membrane and proximal and distal radioulnar joint capsules. A second surgical option has been to perform a rotational osteotomy of the radius. This typically has been performed nonphysiologically by rotating the radius upon itself. A more physiologic approach would be to perform the osteotomy in a manner that allows rotation of the radius around the ulna, as it does in normal forearm pronation. Such an osteotomy has been developed and found to be quick and reliable, resulting in use of muscles not functional with the forearm in static supination and allowing for more effective staged tendon transfers.