Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis

Nguyen Ngoc Hung

doi:10.1007/s11832-008-0146-5

Abstract

To evaluate the clinical and functional results of a technical procedure in the surgical treatment of congenital radioulnar synostosis in children. A prospective study had been undertaken from January 1992 to December 2004. Thirty-four patients with congenital radioulnar synostosis that are fixed in pronation were recruited. Congenital radioulnar synostosis was classified for two types according to Tachdjian's criteria. All patients were treated by resection of the proximal radius and the distal ulna to remove a segmental bone of both parts of the forearm. After K-wires are inserted intramedullarly into both bones, the forearm is derotated manually, followed by cast immobilization. There were 34 patients (52 forearms) with congenital radioulnar synostosis, whom the average age at surgery was 6 years and 3 months. There were two types of congenital radioulnar synostosis: Type 1 in six forearms (11.6%) and Type 2 in 46 forearms (88.4%). The preoperative forearm rotation ranged from 65 degrees to 85 degrees pronation. The postoperative forearm rotation angle was corrected from 0 degrees to 30 degrees ; the best end position appears to be 70-100% of pronation. Of the patients, 78.8% had good or excellent results. All patients were operated on without complications; five patients had loss of correction during cast immobilization. Overall, the patient's ability to perform daily activities showed a marked improvement after surgery. This method is a simple and safe technique to derotate the forearms of patients with congenital radioulnar synostosis that are fixed in pronation.

Highlights

Congenital radioulnar synostosis is an uncommon deformity of the upper limb in which proximal portions of the radius and ulna fuse with each other and restrict the rotation of the forearm
In cases in which the forearm is fixed in pronation over 60° and the patient complains of disability in daily life, derotational osteotomy is recommended to achieve a more functional position
Since 1992, we have developed a method of osteotomy for congenital radioulnar synostosis in which osteotomy is performed at the shafts of the radius and ulna

Summary

Introduction

Congenital radioulnar synostosis is an uncommon deformity of the upper limb in which proximal portions of the radius and ulna fuse with each other and restrict the rotation of the forearm. Disappointing results of earlier attempts to resect the synostosis and restore forearm rotation are reported [2, 3]. Osteotomy is usually performed through the site of fusion, but extensive release of the soft tissue around the osteotomy is mandatory for adequate correction [1, 4, 5]. Soft-tissues tightness may lead to loss of correction or vascular complication because considerable rotation takes place in a very limited area [6, 7, 8]. Most efforts to separate the synostosis and obtain rotation of the forearm have ended in failure

Methods

Results

Conclusion