Derotational Osteotomy and Plate Fixation of the Radius and Ulna for the Treatment of Congenital Proximal Radioulnar Synostosis

Abstract

PurposeTo evaluate the clinical outcomes of derotational osteotomy followed by plate fixation at the radius and ulna for the treatment of congenital proximal radioulnar synostosis.MethodsA total of 10 eligible patients (12 forearms) with congenital proximal radioulnar synostosis were admitted to our institution from January 2013 to January 2016 and treated by radioulnar derotational osteotomy followed by plate fixation. There were 5 males and 5 females with an average age of 5.4 ± 2.0 (3–9) years old. The average forearm position was 56.67 ± 14.36° (range, 40°–80° pronation) in pronation before surgery. According to the classification system of Cleary and Omer, 3 forearms were categorized as type II, 7 as type III, and 2 as type IV. The pre- and postoperative forearm function was recorded and evaluated by the Failla scoring system.ResultsAll included patients were successfully followed up for an average time of 73.90 ± 8.24 months (range, 61–84 months). The mean achieved correction of the forearm was 53.33° ± 12.67° (range, 35°–70°). The average final position was 3.33° ± 14.98° (range, 20° of supination to 25° of pronation) in pronation. Bony union was achieved in a mean of 10.38 ± 1.25 weeks (range, 8.4–12.3 weeks) with no loss of correction. There were no incidences of nonunion, osteomyelitis, or neurologic or circulatory complications. The preoperative functional results were good in 1 forearm, fair in 8 forearms and poor in 3 forearms. In terms of final follow-up functional evaluations, 3 forearms were excellent, 6 forearms were good, and 3 forearms were fair.ConclusionsCongenital proximal radioulnar synostosis can be successfully treated using derotational osteotomy and plate fixation of the radius and ulna, which is an effective method with fewer postoperative complications and expected clinical outcomes.

Congenital Proximal Radioulnar Synostosis in an Elite Athlete–Case Report

“…Similarly, the fixation may be achieved with plate fixation of both the radius and ulna as well. Hamiti et al published 12 forearms in 10 patients (aged 3–9 years) achieving improvement of pronation from 35°–70° to 20°–25° with no complications [ 37 ]. To avoid the postoperative re-ankylosis after surgery the subcutaneous fat or free vascularized fascia lata graft may be used [ 38 ].…”

The relation between radiographic manifestation and clinical characteristics of congenital radioulnar synostosis in children: A retrospective study from multiple centers

“…To the best of our knowledge, this study was the largest cohort on CRUS highlighting the association between radiographic manifestation and clinical forearm functional restriction. In this Several previous studies focusing on the surgical intervention for CRUS highlighted the fixated pronation deformity as one important criterion for surgery (13)(14)(15)(16)), but the latest metaanalysis in 2022 still reached no consensus on the severity of pronation and the necessity of surgery (13). Because of its rarity, most case series did not stress on the correlation of x-ray manifestation and forearm pronation deformity.…”

Sinostosis Radiocubital Congénita. Reporte de caso

“…Se han descrito varias técnicas quirúrgicas pero los resultados son aún inciertos en algunas de estas. Un enfoque altamente aceptado de manejo quirúrgico para el tratamiento de la CRUS que ha ofrecido buenos resultados es la osteotomía desrotacional de acuerdo con Hamiti y colaboradores (22,23).…”

“…En algunos casos se requiere más de una cirugía para alcanzar el objetivo. (22,24) Esta enfermedad puede provocar problemas psicosociales en niños, adolescentes y adultos debido a las difíciles experiencias que enfrentan principalmente los infantes al realizar actividades cotidianas de la vida diaria como lavarse los dientes, bañarse, el uso de utensilios de comida, juguetes entre otros, lo que los lleva a desarrollar una gran variedad de problemas psicológicos a medida que crecen. Afectando gravemente su correcto desarrollo (25).…”