Here again the technique of correction depends on the status of the possible donors,
the associated deficits requiring correction and presence of passive forearm rotation.
Tendon transfer procedures have advantage of maintaining opposite movement but the
bony procedure e.g. forearm osteotomy decreases rotation on the opposite side. In
patients with a fixed deformity, radius pronation osteotomy is the only option. The
prerequisite is anti-gravity wrist extension (MRC grade 3). If absent, this has to
be restored by tendon transfer either at the same sitting or before the osteotomy
procedure lest a wrist drop posture results which is more disabling. If there are
no donors to restore wrist extension, the wrist can be fused in a functional position
and the forearm positioned in pronation with a combined osteotomy procedure.
The tendon transfer options include- biceps rerouting and Brachioradialis rerouting.
Biceps rerouting is a good procedure but it can be done only when the tricpes power
is more than grade 3 or else there is a risk of increasing the flexion deformity at
the elbow in these patients. Brachioradialis rerouting can then be done in such patients
with satisfactory results.