Post-traumatic Radioulnar Synostosis Research Articles

A case report of post traumatic radioulnar synostosis after isolated closed radial head fracture with radial head subluxation

A case report of post traumatic radioulnar synostosis after isolated closed radial head fracture with radial head subluxation

Post-traumatic radioulnar synostosis: a retrospective case series of 10 patients in Kuwait

The development of radioulnar synostosis due to post-traumatic injuries of the elbow or forearm can lead to debilitating outcomes. Several treatment options are available to hinder the progression and prevent recurrence. We used a combination of these treatments in a series of patients and observed the outcomes. We conducted a retrospective study of 10 patients with post-traumatic radioulnar synostosis (9 men and 1 woman) who required surgical intervention in a tertiary orthopedic center. All of these patients were subjected to the same treatment combination (preoperative radiotherapy, tissue interposition after heterotopic ossification resection, and adjuvant indomethacin postoperatively). Improvement in range of motion (flexion, extension, and rotation) and the Mayo score was assessed and compared preoperatively and postoperatively via statistical analysis. In comparison to the patients' preoperative state, which ranged from poor to fair, all 10 patients reported excellent Mayo scores after intervention with the triple therapy combination, with a mean Mayo score of 36±10.2 points. Flexion, extension, and rotation improved by mean values of 55.2°±38.7°, 50.2°±34.0°, and 47.9°±40.0°, respectively. There was 1 complication that has subsided on follow-up. The triple therapy combination was found to provide good functional and prophylactic results preventing recurrence.

外傷性橈尺骨癒合症に対する橈側前腕脂肪筋膜弁による治療 - 2 例報告-

外傷性橈尺骨癒合症に対する橈側前腕脂肪筋膜弁による治療 - 2 例報告-

Optimal management of post-traumatic radioulnar synostosis.

Post-traumatic radioulnar synostosis is a rare complication after forearm or elbow injury that can result in loss of motion and significant disability. Risk factors include aspects of the initial trauma and of the surgical treatment of that trauma. Surgical intervention for synostosis is the standard of care and is determined based on the location of the bony bridge. Surgical timing is recommended between 6 months and 2 years with recent advocacy for the 6- to 12-month period after radiographs demonstrate bony maturation but early enough to prevent further stiffness and contractures. For most types of synostosis, surgical resection with interposition graft is recommended. The types of materials used include synthetic, allograft, and vascularized and non-vascularized materials, but currently there is no consensus on which is the most preferable. Adjuvant therapy is not considered necessary for all cases but can be beneficial in patients with high risk factors such as recurrence or traumatic brain injury. Postoperative rehabilitation should be performed early to maintain range of motion.

Post-traumatic radioulnar synostosis treated effectively with tissue expander capsule interposition: a novel technique

Post-traumatic radioulnar synostosis is a rare condition characterised by abnormal fibro-osseous union between radius and ulna along the length of the interosseous membrane, resulting in loss of forearm pronation and supination. Various surgical techniques have been described and numerous interpositional materials have been used. We present a novel technique of utilising a tissue expander capsule as the interpositional gliding surface. This technique provides an autologous capsule and an expanded adipofascia, which are well vascularised for increased length and reliability.

Management of Posttraumatic Radioulnar Synostosis

Posttraumatic radioulnar synostosis is a rare complication following fracture of the forearm and elbow. Risk factors for synostosis are related to the initial injury and surgical management of the fracture. Typically, patients present with complete loss of active and passive forearm pronation and supination. Evidence of bridging heterotopic bone between the radius and ulna can be seen on plain radiographs. Although nonsurgical management is sufficient in some cases, surgical excision is typically required. The timing of surgical intervention remains controversial. However, early resection between 6 and 12 months after the initial injury can be performed safely in patients with radiographic evidence of bony maturation. Surgical management consists of complete resection of the synostosis with optional interposition of biologic or synthetic materials to restore forearm rotation. A low recurrence rate can be achieved following primary radioulnar synostosis excision without the need for routine adjuvant prophylaxis.

Successful Treatment of a Radioulnar Synostosis in a Mississippi Kite (Ictinia mississippiensis)

A Mississippi kite (Ictinia mississippiensis) was presented to the Wildlife Hospital of Louisiana, School of Veterinary Medicine, Louisiana State University, for an inability to fly and was subsequently diagnosed with a minimally displaced, closed, simple, short oblique, diaphyseal fracture of the distal third of the right ulna. A figure-8 bandage was initially applied to the wing to stabilize the fracture. Over a 5-week period, the kite developed progressive reduction in wing extension, and serial radiographs revealed a bridging callus at the ulnar fracture site, as well as development of a radioulnar synostosis. To restore wing function and extension, surgical excision of the bony union between the radius and the ulna was performed, after which a polypropylene mesh implant was interposed between the 2 bones. Within 2 weeks after the surgical procedure, the kite had recovered normal wing extension and was able to fly without noticeable impairment. The bird was released 2 weeks after surgery. This case illustrates a common complication of external coaptation used as sole means of managing fractures of the avian ulna, radius, or both, which results from lack of interosseous soft tissue in the antebrachial area. On the basis of the successful outcome in this case, surgical excision of the interdiaphyseal callus and interposition of a polypropylene mesh could be a viable option for management of posttraumatic radioulnar synostosis in birds of prey.

Preventing recurrence of radioulnar synostosis with pedicled adipofascial flaps

The surgical treatment of post-traumatic radioulnar synostosis is difficult. Recurrence after resection alone is a concern with poor long-term maintenance of forearm rotation. We report on the use of pedicled adipofascial flaps to prevent recurrence and facilitate maintenance of movement in six adult patients with radioulnar synostosis. Five involved the proximal radioulnar joint and one the distal radioulnar joint. In four the flap was based on the radial artery and in two on the posterior interosseous artery. Mean intraoperative supination was 78° and pronation was 76°. Mean follow up was 32 months. At follow-up, mean supination was 71° and pronation was 70°. No patient had radiological recurrence of synostosis. The only complication was a transient posterior interosseous nerve palsy. Pedicled adipofascial flaps are a safe addition to resection alone which may prevent recurrence and maintain the range of forearm rotation achieved at operation.

Synostose radio-ulnaire post-traumatique de l’adulte

The post-traumatic radioulnar synostosis is a rare complication of forearm fractures. Producing loss of forearm rotation, it is functionally very disabling. The surgical indication, the date of operation, the surgical technique, the interest and the type of adjuvant treatment are all issues that the physician, who will be in charge of a patient suffering from a radioulnar synostosis, must meet. No therapeutic consensus exists so far, but a variety of surgical techniques and adjuvant treatments are suggested. We tried, through a literature review, to identify the factors enabling the synostosis in order to prevent them and define a suitable therapeutic attitude in the light of so far published data.

The Use of Tensor Fascia Lata Interposition Grafts for the Treatment of Posttraumatic Radioulnar Synostosis

There is no agreement on the ideal treatment of traumatic radioulnar synostosis, especially the type of interposition material to be used. The purpose of this study is to report our experience with synostosis resection and interposition of tensor fascia lata grafts. A chart review was conducted for all patients treated for posttraumatic radioulnar synostosis between 2000 and 2004. Demographic data, mechanism of injury, length of time to synostosis resection, range-of-motion, patient satisfaction, and postoperative complications were analyzed. Thirteen patients were identified for this study. The mean preoperative pronation was 14 degrees and the mean postoperative pronation was 62 degrees. The mean preoperative supination was 4 degrees and the mean postoperative supination was 62 degrees. The mean follow-up time was 30 months. These results indicate that synostosis resection with tensor fascia lata graft interposition is an effective technique for the treatment of posttraumatic radioulnar synostosis. Therapeutic, Level IV.

In vivo three‐dimensional motion analysis of the forearm with radioulnar synostosis treated by the kanaya procedure

Attempts to separate congenital radioulnar synostosis and restore forearm rotation had been disappointing until a new mobilization technique was developed by Kanaya and colleagues using free vascularized fascio-fat graft interposition. This technique provides a functional rotation arc, but postoperative forearm motion is difficult to evaluate given the inaccuracies in determining the range of motion and rotational axis using conventional x-rays or computed tomography. This study represents an attempt to analyze in vivo three-dimensional motion of the forearm with radioulnar synostosis treated by Kanaya's operation using a markerless bone registration technique. Six patients with seven postoperative forearms (six with congenital and one with posttraumatic radioulnar synostosis) underwent 3D computed tomography with the forearm in neutral, fully pronated, and fully supinated positions. Range of motion according to this method was 30 +/- 18 degrees, significantly smaller than the 82 +/- 29 degrees from manual examination. Improvements in range of motion were significantly greater in cases without dislocation of the radial head (46 +/- 13 degrees) than in cases with dislocation (19 +/- 10 degrees). Dislocation of the radial head was also significantly correlated with an abnormal axis of rotation of the forearm.

Proximal radio-ulnar synostosis with radial neck non-union in a case of undisplaced fracture of the radial

We report the case of a 70-year-old male who presented with persistent pain around the left elbow four months after sustaining an undisplaced fracture of the radial neck which was treated conservatively. Radiographs of the elbow revealed proximal-radio-ulnar synostosis with non-union of the radial neck. As far as we are aware, this is the only case of post-traumatic radio-ulnar synostosis with non-union reported in a case of undisplaced fracture of the radial neck in English literature.

Posttraumatic Radioulnar Synostosis Treated With a Free Vascularized Fat Transplant and Dynamic Splint

Two cases of posttraumatic radioulnar synostosis are presented. The patients were treated with excision of the cross-union and interposition of a free vascularized fat transplant. A newly devised pronation-supination dynamic splint was employed for 3 months postoperatively in both patients. After a 1-year postoperative follow-up, an increased range of motion was restored in both cases, and there was no evidence of recurrent synostosis formation in subsequent radiographs. We suggest that an interposed vascularized fat graft may be an ideal biologic barrier to fill the space created by cross-union excision.

A case of bilateral post-traumatic radio-ulnar synostosis

A case of bilateral post-traumatic radio-ulnar synostosis

Surgical Treatment of Posttraumatic Radioulnar Synostosis in Children

The authors describe two children who underwent surgical treatment of radioulnar synostosis. One case involved simple excision; the other, excision and interposition of Gore-Tex vascular graft material. In a review of the literature, no other report of the latter type of surgical treatment was found. A discussion of the literature concerning this rare complication in children and the current surgical treatment options are included.

Posttraumatic proximal radioulnar synostosis: Technique for operative resection

Objectives Resection of a posttraumatic proximal radioulnar synostosis to gain pronation and supination of the forearm.

Treatment of traumatic radioulnar synostosis by excision and postoperative low-dose irradiation

Post-traumatic radioulnar synostosis can have a profound effect on upper extremity function. Prior reports of excision, with and without interposition material, have demonstrated frequent recurrence and disappointing results. Based on a favorable experience with radiation prophylaxis of heterotopic ossification following total hip arthroplasty, this modality has been used in the management of post-traumatic forearm synostosis. Four cases using excision of bony synostosis followed by single-fraction, low-dose (800 cGy), limited-field irradiation are presented. With a follow-up period of 1–4 years after excision and irradiation, all four patients had total arcs of forearm rotation between 115° and 120°. Each patient noted sustained functional improvement, and there was no x-ray film evidence of recurrent synostosis formation. Single fraction irradiation did not require ongoing patient compliance nor did it complicate rehabilitative efforts. Furthermore, soft tissue and bony healing were not impaired.

Radio-ulnar synostosis following external fixation

Post-traumatic radio-ulnar synostosis is an unusual but serious complication of adult forearm fractures. This is the first report of radio-ulnar synostosis following external fixation to be described in the English literature. A 52-year-old man sustained a fracture of the distal radius and ulna which was managed by external fixation. Following this, he developed a radio-ulnar synostosis at the pin-track site. The synostosis was successfully removed and he regained significant rotatory movement of his forearm.

Treatment of posttraumatic radioulnar synostosis with excision and low-dose radiation

Two cases of posttraumatic radioulnar synostosis treated with excision and low-dose radiation are presented. Routine postoperative hand therapy was employed. Nearly full range of motion was restored in both cases. No wound healing problems were encountered. We suggest that lowdose radiation may be a useful method of prophylaxis against recurrence after excision of radioulnar synostosis.

外傷性とう尺骨癒合症の一例

Post-traumatic radioulnar synostosis is infrequent, especially following an isolated ulnar shaft fracture, it is very rare. The patient was a 48-year-old man, who was injured by taffic accident. 6 months after intramedullary fixation of the right ulna, he complained of restriction of active or passive forearm rotation. An examination showed that his forearm was fixed in neutral position. 10 months after the osteosynthesis, we treated him surgically with excision of the synostosis, encircling of raw surface of ulna by a silastic sheet and transplantation of free fat. At present, 10 months after the operation, he has gained an active range of motion of 40° pronation and 45° supination. He was graded excellent by Vince and Miller's evaluation, but we should follow him up because of a new bone formation of the synostosis.