Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

Abstract

Posttraumatic proximal radioulnar synostosis (PPRUS) is a severe complication of radial head and neck fractures known to occur after severe injury or operative fixation. Cases of PPRUS occurring after minimally displaced, nonoperatively treated radial neck injuries are, by contrast, extremely rare. Here, we present a pediatric case of PPRUS that developed after a nonoperatively treated minimally displaced radial neck fracture with concomitant olecranon fracture. While more cases are needed to establish the association between this pattern of injury and PPRUS, we recommend that when encountering patients with a minimally displaced radial neck fracture and a concomitant elbow injury, the rare possibility of developing proximal radioulnar synostosis should be considered.

Fractures of the proximal radius in children: management and results of 100 consecutive cases

“…Some comparative studies have not shown significant differences in the results after closed and open reduction, and this supports the hypothesis that fracture type and initial degree of dislocation are the most important elements for determining functional outcomes [ 25 ]. In contrast, most authors observed a correlation of open reduction with a high rate of complications, such as myositis ossificans [ 26 ], synostosis [ 27 ], and pseudarthrosis [ 7 ]. One of the most feared complications is avascular necrosis of the radial head and nonunion [ 7 , 20 ], and this sometimes requires radial head resection as an ultimate ratio to restore at least a limited pro-/supination.…”

Post-traumatic radioulnar synostosis: a retrospective case series of 10 patients in Kuwait

“…Finally, a direct approach was performed for the ulna. In stage with indomethacin, radiotherapy, and HO resection [13][14][15]23 ; dual therapy with indomethacin and HO resection, 24 and intramedullary nailing. 25 Regardless of what preoperative management is performed, surgical intervention remains the most effective option to restore functional range of motion in patients with limited pronation and supination.…”

“…These include the use of adjuvant indomethacin, radiation therapy, and interposition flaps such as adipose tissue, anconeus, or tensor fascia lata. [13][14][15] Some authors have even suggested the combination of all 3 modalities to achieve better results. [16][17][18] The main aim of this study was to report on cases that underwent surgery with a combination of prophylactic triple therapy to confirm that the results are consistently excellent and in keeping with the experiences shared by other centers.…”

Management of Radial Neck Fractures

“…Some evidence suggests that increased radial head angulation and/or displacement, as well as associated elbow injuries, may increase the risk of radioulnar synostosis. 30…”