Abstract
Congenital radioulnar synostosis is defined as fusion of the proximal ends of the radius and ulna. There is no rotational motion of the radius around the ulna. A patient with congenital radioulnar synostosis in neutral or pronation has severe disabilities in activities of daily living. Derotational osteotomy at the site of synostosis or the diaphysis of the radius and ulna in order to fix the forearm in neutral or mild pronation is currently the accepted treatment for synostosis. 2 Green W.T. Mital M.A. Congenital radio-ulnar synostosis surgical treatment. J Bone Joint Surg Am. 1979; 61: 738-743 PubMed Google Scholar , 8 Miura T. Nakamura R. Suzuki M. Kanie J. Congenital radio-ulnar synostosis. J Hand Surg [Br]. 1984; 9: 153-155 Crossref PubMed Scopus (33) Google Scholar , 11 Simmons B.P. Southmayd W.W. Reiseborough E.J. Congenital radioulnar synostosis. J Hand Surg [Am]. 1983; 8: 829-837 Abstract Full Text PDF PubMed Scopus (90) Google Scholar Most efforts to separate the synostosis and obtain rotation of the forearm have ended in failure. Yabe 12 Yabe Y. New operative method for congenital radio-ulnar synostosis. Seikei Geka. 1971; 22 ([in Japanese]): 900-903 PubMed Google Scholar released the synostosis and interposed the anconeus muscle to preserve the separation of the radius and ulna. Miura et al 8 Miura T. Nakamura R. Suzuki M. Kanie J. Congenital radio-ulnar synostosis. J Hand Surg [Br]. 1984; 9: 153-155 Crossref PubMed Scopus (33) Google Scholar performed Yabe's procedure and reported that all 8 cases resulted in recurrence of the synostosis. Ikegami et al 4 Ikegami H, Takayama S, Nakao Y, Yabe Y, Horiuti Y. Congenital radioulnar synostosis treated with a interposition of anconeus. J Jpn Elbow Soc 2001;8:49-50 Google Scholar reported that 5 of 7 cases achieved forearm rotation after Yabe's procedure. The technique of Kanaya and Ibaraki, 5 Kanaya F. Ibaraki K. Mobilization of a congenital proximal radioulnar synostosis with use of a free vascularized fascio-fat graft. J Bone Joint Surg Am. 1998; 80: 1186-1192 PubMed Google Scholar which uses a free vascularized fat graft with a branch of the profunda humeri vessels to fill the dead space after separation of the synostosis, was successful in all 7 patients. Kanaya's method requires microvascular anastomosis and has a risk of vascular occlusion. We have devised a new method, modifying Kanaya's procedure. The following case demonstrates the advantages of using a proximally based posterior interosseous vessel fat flap, allowing the space between the radius and the ulna to be filled after separation of the synostosis.
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