Static Progressive Forearm Rotation Contracture Management Orthosis Design: A Study of 28 Patients

摘要

Loss of forearm rotation can lead to significant loss of upper limb function. Operative treatment to improve rotation of the forearm at both the proximal radioulnar joint and distal radioulnar joint has been reported. There are limited orthosis designs available to address this clinical problem and limited information about the efficacy of conservative management of forearm rotation stiffness. A unique orthosis design was fabricated to provide static progressive motion for forearm rotation motion: supination and pronation. The orthosis design consisted of a custom-molded polyethylene hinged elbow orthosis with a dual offset channel overlapping an adjustable rotation component. Attempts were made to align the anatomical axis for forearm rotation motion with the mechanical axis of the orthosis. All orthoses used were adjustable from full supination to full pronation range of motion. A study was carried out to track the progress and results of 28 patients with loss of forearm rotation. Patients with synostosis or malunion of forearm fractures were excluded. Patients were included if they had 50~O or less of supination, pronation, or both. Average initial supination was 33.2~O, and final supination averaged 68.1~O. Average gain was 36.5~O. Twenty-three patients (92%) gained motion, 17 (68%) gained a functional arc. Initial pronation averaged 49.3~O, and final pronation was 74.0~O, Average pronation gain was 25.8~O, This report describes the design details and the fit criteria and challenges. It also demonstrates the effectiveness of this type of static progressive stretching to improve forearm stiffness related to soft tissue contracture.