Derotational shortening osteotomy at proximal 1/3 and middle 1/3 of the ulna and radius for the treatment of congenital proximal radio-ulnar synostosis

Abstract

Objective To explore the clinical efficacy and safety of derotational shortening osteotomy at proximal 1/3 and middle 1/3 of the ulna and radius for the treatment of congenital proximal radio-ulnar synostosis, and to determine the optimal forearm position. Methods From February 2010 to April 2016, 36 cases (44 forearms) with congenital proximal radio-ulnar synostosis were treated by derotational shortening osteotomy at proximal 1/3 and middle 1/3 of the ulna and radius. The forearm was fixed at 30° to 110° of pronation before the operation. The forearm was placed in a certain supination position during the operation, and the osteotomy end was fixed with plate and screw. The forearm position was measured at the time of internal fixator removal and last follow-up, and the forearm rotation range after shoulder compensation was measured before and after operation. Results All the patients were follow-up for 18 to 72 months, with an average of 31 months. The forearm was fixed at -10° to 80° of supination, with an average of (33. 64±19. 66)° on the left side and (21. 36±14. 51)° on the right side. The degree of correction was 60° to 140°. The range of pronation after shoulder compensation was (188. 18±10. 44)° and (122. 58±20. 43)° before and after the operation respectively, while the range of supination was (-33. 64±33. 52)° and (60. 30±27. 07)°. The difference was statistically significant before and after operation (P 0. 05). The results from the right side were the same as those from the left side. The plate of radius was broken in 4 cases. No complications such as fracture of ulnar plate, nonunion of fracture, deformity recurrence, forearm ischemic contracture and neurovascular injury were observed in all patients. Conclusion The derotational shortening osteotomy at proximal 1/3 and middle 1/3 of the ulna and radius is safe and effective for the treatment of congenital proximal radio-ulnar synostosis. Placing forearm at 30° to 50° of supination is better for the function of forearm and hand. Key words: Osteotomy; Treatment outcome; Congenital proximal radio-ulnar synostosis; Deformity