Effect of Radioulnar Derotational Osteotomy on Hand Function in Patients With Brachial Plexus Injury: A Case Series Study

Background: Childhood brachial plexus injury (BPI) is a severe nerve injury leading to significant functional impairments, including supination deformities that restrict hand function and complicate daily activities. This study aimed to evaluate the effect of radioulnar derotational osteotomy (RUDO) on hand function in children with BPI and supination deformity. Methods: A case series of 16 BPI patients (mean age: 7.44 ± 1.26 y) undergoing RUDO at a tertiary care center from 2019 to 2023 was analyzed. Inclusion criteria encompassed supination deformity with a minimum 12-month follow-up and functional wrist motion. Hand function was assessed preoperatively and postoperatively using the Functional Grasp Scale (FGS) and Activities of Daily Living (ADL) scores. Statistical analysis was conducted to compare outcomes. Results: RUDO significantly improved functional outcomes. The mean FGS score rose from 2.81 ± 4.17 preoperatively to 6.13 ± 2.99 postoperatively ( P < 0.001). Similarly, the mean ADL score increased from 1.50 ± 0.99 to 8.69 ± 1.65 ( P < 0.001). Subdomains of ADL, including domestic activities and physical self-maintenance, showed significant enhancements. No group-specific differences were observed in functional improvement, indicating consistent benefits across varying preoperative finger function statuses. Conclusions: RUDO is a minimally invasive, effective procedure that significantly enhances hand function and daily living capabilities in children with BPI and supination deformity. This technique offers reliable functional improvements. Further longitudinal studies are needed to confirm sustained benefits. Level of Evidence: Level IV—case series.