Congenital Radioulnar Synostosis Research Articles

Nursemaid Elbow Revisited and a Review of Congenital Radioulnar Synostosis

Nursemaid Elbow Revisited and a Review of Congenital Radioulnar Synostosis

Congenital radioulnar synostosis: a case report of a probable subtype

AbstractWe present a case of bilateral congenital radioulnar synostosis in which computed tomography examination revealed osseous outgrowths of the ulna. Their excision resulted in 125° range-of-motion of the forearm rotation.

The use of pedicled posterior interosseous fat graft for mobilization of congenital radioulnar synostosis: a case report

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.

Derotational osteotomy at the shafts of the radius and ulna for congenital radioulnar synostosis

Purpose: The purpose of this study was to describe the results of a newly developed method of correction osteotomy for congenital radioulnar synostosis. With this method the osteotomy is performed at the distal one third of the radius and proximal one third of the ulna. After K-wires are inserted intramedullarly into both bones the forearm is derotated manually to the position planned before surgery followed by cast immobilization. Methods: Four patients with an average age of 3.9 years underwent surgery with this method and were followed-up for 45.8 months. All of their forearms were fixed before surgery at over 70° of pronation. Results: The average correction after surgery was 65° and bone union occurred at 8 weeks after surgery without any complications. The patients' ability to perform daily activities showed a marked improvement after surgery, but there was a 20° loss of correction during cast immobilization in one case. Conclusion: This method is a simple and safe technique to derotate the forearms of the patients with congenital radioulnar synostosis that are fixed in pronation. (J Hand Surg 2003;28A:133-137. Copyright © 2003 by the American Society for Surgery of the Hand.)

Forearm Length Discrepancy in Unilateral Congenital Proximal Radioulnar Synostosis

Purpose : Forearm lengths in cases of unilateral congenital radioulnar synostosis, were analysed radiographically to evaluate the amount of length discrepancy according to different types. Materials and Methods : We measured the ulnar length ratio (length of affected forearm/length of unaffected forearm) in 15 cases of unilateral congenital radioulnar synostosis. We observed two distinct radiographic patterns. Type I (Lamda type) appeared to be of character grossly, and showed severe radial bowing and a severely hypoplastic radial head. Type II (Chi type) seemed like in character, showed mild radial bowing and a mildly hypoplastic, or normal radial head. Results : Nine cases were type I and 6 were type II. The ulnar length ratio was 0.89 in type I and 0.98 in type II. Significant differences were formed in the ulnar length ratios between normal subject and type I, and between type I and type II (page (year)'. Conclusion : Unilateral congenital radioulnar synostosis can be classified into two types according to radiological morphology. This classification can be helpful in the prediction of forearm length discrepancy, and in the determination of surgical treatment type.

Congenital Radioulnar Synostosis in an Active Duty Soldier: Case Report and Literature Review

Congenital radioulnar synostosis (CRS) is a developmental deformity that interferes with pronation and supination of the upper extremity. CRS often results in functional, cosmetic, and cultural limitations. The purpose of this paper is to present a patient with CRS who is currently functioning as a generator mechanic in the U.S. Army and to review the literature for current treatment options. We know of no other individual in the U.S. Army who is on active duty status with this deformity.

Congenital radioulnar synostosis: Study of a series of 37 children and adolescents

The authors report a retrospective series of 37 patients (49 forearms) with congenital radioulnar synostosis followed and treated at Raymond Poincaré University Hospital. This disease is rare, but much more frequent than post-traumatic or humeroradial synostosis. A genetic factor was incriminated in 25% of patients. The clinical study was based on 31 files (40 forearms) with a subjective finding of hypermobility of the wrist in all patients. Shortening of the ipsilateral upper extremity < or = 2 cm was also observed in one third of patients, and a defect of elbow extension was observed in 35%. The radiological study, conducted on 30 files (38 forearms), confirmed the existence of several degrees of fusion within the synostosis and revealed an associated radiological abnormality in 92% of cases. The only valid correlation revealed was between the degree of fusion of the synostosis and the presence of a morphological abnormality of the radial head (r = 0.87), hence the proposal of a new radiological classification essentially based on this element. Functional adaptation was excellent in the majority of cases. The authors propose two main indications for surgery: hyperpronation > or = 90 degrees and bilateral synostosis; in both cases, the disability must be very severe. The operative technique used appeared to be very well adapted to this disease: "reed" radial osteotomy and transverse ulnar osteotomy. No complications or relapses were observed in six operated patients with a mean follow-up of 10 years, with a mean loss of derotation of only 5 degrees.

Surgical Treatment of Congenital Radioulnar Synostosis

Surgical Treatment of Congenital Radioulnar Synostosis

Autosomal dominant and sporadic radio-ulnar synostosis

We report on seven cases of congenital radio-ulnar synostosis (RUS). Five were found in the same family and two were sporadic. In six the synostosis was bilateral and consistently involved the proximal end of the radius and ulna. In the familial cases the anomaly was inherited as an autosomal dominant trait and was associated with a Dubois sign and relative shortness of metacarpals number 4 and 5 in two patients, and of number 2 in another patient, and of all phalanges of the 5th fingers. These observations suggest involvement of an ulnar developmental field. RUS does not seem to be rare in the Sicilian population.

Congenital radioulnar synostosis: Surgical correction by derotational osteotomy

We have evaluated 4 cases of congenital proximal radioulnar synostosis corrected by proximal derotational osteotomy. Surgery was only indicated in cases with more than 60 degrees of pronation. Mean age at the time of surgery was 7 years and 4 months and mean postoperative follow-up time was 8 years. Forearm position after surgery ranged from 15 to 0 degrees of pronation. Aesthetic and functional improvement was achieved in all cases. No complications were observed the Surgical technique is reviewed.

Osteotomy of the synostosis mass for the treatment of congenital radio-ulnar synostosis.

Our experience with the surgical treatment of radio-ulnar synostosis in the period from 1985 to 1992 is reviewed. Operative procedures were performed in eight patients with radio-ulnar synostosis. In five patients bilateral, and in three patients unilateral, synostosis was present. The results were better in patients in whom synostosis mass osteotomy perpendicular to the longitudinal axis of the forearm was performed. Usually, treatment attempts to achieve a neutral position for the forearm. This position is more suited to unilateral synostosis than to bilateral synostosis. Vascular and/or neurological complications did not arise during the operation or during the follow-up period. All patients were satisfied with the operative outcome.

Surgical Treatment of Congenital Radioulnar Synostosis

Surgical Treatment of Congenital Radioulnar Synostosis

Congenital radio-ulnar synostosis: Compensatory rotation around the wrist and rotation osteotomy

In order to make clear the clinical features of congenital radio-ulnar synostosis, compensatory rotation around the wrist and functional results after rotation osteotomy, 40 cases of congenital radio-ulnar synostosis have been analysed. The mean pronation of the ankylosed forearm in those who complained of disabilities in daily life was 60.7° and that in patients without complaints was 21.2°. In almost all cases with total ankylosis, the forearm had compensatory movement around the wrist, the mean arc being from 76.3° of pronation to 42.9° of supination. 13 limbs in 11 patients treated by transverse rotational osteotomies through the fusion mass have followed up for over two years. The functional results after surgery were satisfactory in all patients. Rotational osteotomy of the forearm is a useful and reliable treatment for congenital radio-ulnar synostosis.

Congenital radio-ulnar synostosis: compensatory rotation around the wrist and rotation osteotomy.

In order to make clear the clinical features of congenital radio-ulnar synostosis, compensatory rotation around the wrist and functional results after rotation osteotomy, 40 cases of congenital radio-ulnar synostosis have been analysed. The mean pronation of the ankylosed forearm in those who complained of disabilities in daily life was 60.7 degrees and that in patients without complaints was 21.2 degrees. In almost all cases with total ankylosis, the forearm had compensatory movement around the wrist, the mean arc being from 76.3 degrees of pronation to 42.9 degrees of supination. 13 limbs in 11 patients treated by transverse rotational osteotomies through the fusion mass have followed up for over two years. The functional results after surgery were satisfactory in all patients. Rotational osteotomy of the forearm is a useful and reliable treatment for congenital radio-ulnar synostosis.

CONGENITAL PROXIMAL RADIO-ULNAR SYNOSTOSIS. NATURAL HISTORY AND FUNCTIONAL ASSESSMENT

We evaluated the cases of twenty-three patients with thirty-six congenital proximal radio-ulnar synostoses who had been followed between 1938 and 1984. None of the patients had had any attempt at surgical correction or any ipsilateral congenital anomalies. Emphasis was placed on analyzing the natural history of the lesion in these patients who had not been operated on, and on determining the effect of a fixed position of the forearm on function. Ten patients had unilateral and thirteen, bilateral synostosis. Their mean age when last examined was twenty-two years (range, three to fifty years). Eight patients were female and fifteen, male. The forearms were fixed in an average of 30 degrees of pronation. The position of the forearm was not found to be related to subjective functional limitations, employment status, or the results of the hand-function test of Jebsen et al. Most patients had few or no functional limitations, and were employed in jobs that demanded extensive use of the forearm. Contrary to the findings of other studies, we observed four distinct radiographic patterns based on the presence of an osseous synostosis and the position of the radial head. However, we noted no relationship between any of these patterns and function. We concluded that operative treatment of congenital radio-ulnar synostosis is rarely indicated, that less emphasis should be placed on the single factor of the position of the forearm, and that objective functional tests should be included in the assessment of these patients.

Congenital proximal radio-ulnar synostosis. Natural history and functional assessment.

We evaluated the cases of twenty-three patients with thirty-six congenital proximal radio-ulnar synostoses who had been followed between 1938 and 1984. None of the patients had had any attempt at surgical correction or any ipsilateral congenital anomalies. Emphasis was placed on analyzing the natural history of the lesion in these patients who had not been operated on, and on determining the effect of a fixed position of the forearm on function. Ten patients had unilateral and thirteen, bilateral synostosis. Their mean age when last examined was twenty-two years (range, three to fifty years). Eight patients were female and fifteen, male. The forearms were fixed in an average of 30 degrees of pronation. The position of the forearm was not found to be related to subjective functional limitations, employment status, or the results of the hand-function test of Jebsen et al. Most patients had few or no functional limitations, and were employed in jobs that demanded extensive use of the forearm. Contrary to the findings of other studies, we observed four distinct radiographic patterns based on the presence of an osseous synostosis and the position of the radial head. However, we noted no relationship between any of these patterns and function. We concluded that operative treatment of congenital radio-ulnar synostosis is rarely indicated, that less emphasis should be placed on the single factor of the position of the forearm, and that objective functional tests should be included in the assessment of these patients.

Congenital radio-ulnar synostosis

Thirty-three patients with congenital radio-ulnar synostosis were examined. There was one familial predisposition. Chromosomal patterns were examined in seventeen patients and were normal. Bone maturation appeared normal. The radial deviation angle, in the patients whose distal radial epiphysis had closed, was elevated (Madelung's deformity). However, in the patients whose distal epiphysis maturation score was 8, it was not elevated. On the other hand, elongation of the ulna (plus variant) and/or dorsal dislocation of the distal end of the ulna was seen in early life. In terms of treatment, all attempts to divide the two bones failed. It was found that derotation of the nonwriting hand by an osteotomy through the proximal fusion mass was a useful procedure.

Congenital radioulnar synostosis

Congenital radioulnar synostosis can be severely disabling, especially if it is bilateral or if severe hyperpronation exists. Functionally, patients with severe deformity have trouble getting a cup to the mouth, using eating utensils, or accepting objects in an open palm. Of 33 patients (17 bilateral and 7 unilateral) underwent derotational osteotomy, with the majority being performed through the synostosis held with, an intramedullary wire and secondary transfixing device. There were eight complications, four involving neurovascular compromise. In bilateral cases, the best end position appears to be 10% to 15% of pronation in the dominant extremity and neutral in the other. Eighty-two percent of the patients had good or excellent results.

Congenital radio-ulnar synostosis: Surgical treatment: W. T. Green and M. A. Mital. J Bone Joint Surg 61A:738–743, (July), 1979

Congenital radio-ulnar synostosis: Surgical treatment: W. T. Green and M. A. Mital. J Bone Joint Surg 61A:738–743, (July), 1979

Congenital radio-ulnar synostosis in children: G. Finidori, P. Rigault, F. Barthel, et al. Chirurgie Pédiatrique, Paris, 19:211–217, (July–August), 1978

Congenital radio-ulnar synostosis in children: G. Finidori, P. Rigault, F. Barthel, et al. Chirurgie Pédiatrique, Paris, 19:211–217, (July–August), 1978