The Dorsoulnar Artery Perforator Adipofascial Flap in the Treatment of Distal Radioulnar Synostosis

Abstract

Posttraumatic radioulnar synostosis (RUS) is a rare event following forearm fractures. Consequences are disabling for patients who suffer from functional limitation in forearm pronosupination. Distal RUS are even more rare and more difficult to treat because of high recurrence rates. The patient we describe in this paper came to our attention with a double distal RUS recurrence and a Darrach procedure already performed. We performed a radical excision of RUS and interposition with a vascularized dorsoulnar artery (DUA) adipofascial perforator flap. Four years after surgery, the patient shows the same complete range of motion in pronosupination, and MRI confirms that the flap is still in place with signs of vascularization. Simple synostosis excision has been proven ineffective in many cases. Interposition is recommended after excision, and biological material interposition seems to be more effective than foreign material. Surgeons are increasingly performing vascularized interposition, and the results are very encouraging.

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

“…[9][10][11][12] A consensus on the gold-standard treatment modality has yet to be reached, although an exhaustive list of options has been reported in the literature. These options include, but are not limited to, the reverse Sauv e-Kapandji procedure 19,20 ; tissue expander capsule interposition 21 ; posterior interosseous antegrade-flow pedicled flap 22 ; triple therapy In stage 1, d ebridement was performed, followed by external fixation using 2 Schanz screws (4 mm) in the humerus, 2 Schanz screws (4 mm) in the proximal ulna, 2 Schanz screws (4 mm) and subcutaneous K-wires in the distal radius, and 2 Schanz screws (3 mm) in the MCP. In stage 2, d ebridement was performed, followed by exploration of the ulnar and median nerve (intact), MCL repair, and insertion of Ethibond pullout suture (Ethicon, Somerville, NJ, USA) for the coronoid fracture.…”

“…29 More commonly, patients presenting with extensive softtissue injury, head injury, fracture comminution, or Monteggia-type fracture, among others, are at risk of radioulnar synostosis development. 1,4,5 Less common risk factors include biceps tendon repair, 2 congenital development, 19 percutaneous fixation of distal radial and ulnar styloid fractures, 20 and intramedullary nailing. 25 In all the patients in our study, radioulnar synostosis developed due to the most common causedfractures.…”