United Brachial Plexus Network, Inc.

My 7 year old son is a ROBPI. He just had the triangle tilt done by Dr. Nath in November. Now that his shoulder is lined up, his forearm over-supinates. He will need a forearm osteotomy to line up the bones properly in his forearm so that he will be able to pronate. He is able to get his hand into neurtral. Has anyone had to do this? If so, what was your experience, where did you have this done, and what was the outcome? Thanks.

My son is almost 5 and having the same issues, he did not have the triangle tilt though, he had a different surgery. Anyway we are opting to do a tendon transfer in the forearm in hopes of avoiding an osteotomy later on. His surgery is scheduled for April 18th.

Cindy

Erin,
My son had both of these surgeries and is doing great. It really made an amazing difference. He is able to use his arm and hand so much more effectively. I will e-mail you with more details.
Andrea.

Andrea,

Would you be willing to share details with me, too? My son just had the Triangle Tilt (he's still in the splint) and Dr. Nath mentioned that the forearm osteotomy may be a possibility for Michael.

Thanks

Sally

It is my understanding that you trade internal rotation for external in this procedure. This leaves a pronated arm more in a supinated spot.

Guest,
Could you please clarify because I don't understand what you are saying. This post is referring to a FOREARM osteotomy. Sometimes once the shoulder is in a better position from having the triangle tilt surgery it leaves the forearm in a supinated position. This causes the hand to be in a palm up position. With the forearm osteotomy, the radius is cut and repositioned into more of a neutral position. The patient is still able to supinate after the surgery, but now they also have the ability to pronate because the bone isn't blocking that movement anymore. My son has had great results from this surgery and he didn't "trade" anything for anything. The rotation of his radius has just made his "starting point" in a different place. Instead of his bones starting in a supinated posture and only being physically able to get to neutral, now he is starting in neutral and is able to both supinate and pronate. If you have a different understanding, please clarify. Thank you.
Andrea.

Hi andrea,

Apologies if i have muddied the waters. Most parents i have talked with explain that after the tt the arm is in a position of external rotation, but over time it eases in more toward neutral. My thoughts were that this was what was going on, but I guess if things do not go back internally then further treatment may be needed.

Guest,
After reading this post again, I think I may have misunderstood the point you were making. Are you saying that the Triangle Tilt surgery trades internal for external rotation? Althought that would make more sense, that isn't necessarily true either. My son could NOT put his hand behind his back or on the side of his leg before the triangle tilt surgery. After he was out of that splint and healed, he was able to put his hand behind his back and place things into a side pocket on his pants. Once the shoulder was in a better place, it allowed him to use his internal rotaters effectively without his shoulder staying in internal rotation. His external rotation has dramatically improved as well. He easily touches the back of his head, neck, ear, etc. So, once again, he didn't "trade" anything for anything. Sorry for the confusion.
Andrea

Guest,
No problem and no apologies necessary, no "waters are muddied" at all! I was just trying to explain the way that I understood things to help answer the original posters question. My son's arm was in a neutral position after the triangle tilt surgery and has stayed that way, which is the same thing that I have heard from the parents that I have spoke with. I guess that is why you always hear that every child is different. Has your child had either of these surgeries? If so, it would be nice to talk to you and we could compare "notes". You can e-mail me privately if you want.
Andrea

I forgot to add that my son's arm was slightly supinated prior to the tt surgery, so when the shoulder was in a better position, his forearm was over-supinated. We knew going into the tt surgery that the forearm osteotomy was a possibility.