Abstract
BackgroundThe aim of this study was to assess the feasibility and efficacy of proximal radioulnar derotational osteotomy followed by internal fixation for the treatment of congenital radioulnar synostosis (CRUS).MethodsBetween May 2008 and August 2016, 31 patients (36 forearms) with CRUS who underwent derotational osteotomy at the proximal radioulnar synostosis site were evaluated. There were 20 boys and 11 girls. The mean age at the time of surgery was 4.87 ± 3.06 (range, 2 to 13) years. The forearm was derotated to the goal position (20 degrees of supination to 10 degrees of pronation) using plates for internal fixation and plaster splints for external immobilization. Pre- and postoperative positions of the forearm were recorded; forearm function was evaluated based on the classification system proposed by Failla et al.ResultsThe mean follow-up duration was 55.19 ± 27.10 (24 to 123) months. The mean initial pronation deformity was 62.92 ± 7.11 (55 to 80) degrees. The mean correction achieved was 70.86 ± 9.58 (50 to 90) degrees, resulting in a mean final position of 7.94 ± 7.25 degrees of supination (20 degrees of supination to 10 degrees of pronation). Based on the Failla classification system, 2 forearms were rated as good, 30 were rated as fair, and 4 were rated as poor preoperatively. At the final follow-up, 34 forearms were rated as excellent and 2 were rated as good. All patients achieved bone union after 2 months. Complications occurred in three patients (two transient nerve palsies and one compartment syndrome), and the overall complication rate was 9.7%.ConclusionsProximal radioulnar derotational osteotomy followed by plate fixation is a safe and feasible procedure with a low complication rate. The technique can effectively improve the function of the forearm.Level of evidence IVRetrospective case series
Highlights
Congenital radioulnar synostosis (CRUS) is a rare congenital skeletal malformation of the upper limb that can be extremely disabling, especially when it occurs bilaterally or if severe hyperpronation is present [1]
Derotational osteotomy remains the most commonly performed procedure in patients with congenital radioulnar synostosis (CRUS) [3, 5,6,7,8], which alters the position of the forearm from hyperpronation to a more functional position to reduce supination limitations and to allow patients to more perform activities of daily life
There are many types of osteotomy and fixation methods, including derotational osteotomy at the synostosis site with K-wire fixation [9], one-stage or two-stage double-level derotational osteotomy of the ulna and the radius fixed with plaster casts [7, 10], one- stage double-level derotational osteotomy of the ulna and the radius with K-wire fixation [11, 14], and single osteotomy of the radial diaphysis fixed with plaster casts [8, 15]
Summary
Congenital radioulnar synostosis (CRUS) is a rare congenital skeletal malformation of the upper limb that can be extremely disabling, especially when it occurs bilaterally or if severe hyperpronation is present [1]. Surgical separation and reconstruction techniques had theoretically been considered the ideal treatment, taking into account both correction of the deformity and reconstruction of forearm rotational function, but the final outcomes are not satisfactory [12, 13]. Derotational osteotomy remains the most commonly performed procedure in patients with CRUS [3, 5,6,7,8], which alters the position of the forearm from hyperpronation to a more functional position to reduce supination limitations and to allow patients to more perform activities of daily life. The aim of this study was to assess the feasibility and efficacy of proximal radioulnar derotational osteotomy followed by internal fixation for the treatment of congenital radioulnar synostosis (CRUS)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
