Proximal Radioulnar Synostosis Research Articles

Posttraumatic proximal radioulnar synostosis: Current concepts on the clinical presentations, classifications, and open surgical approaches

In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6–12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.

Prenatal and neonatal phenotype of Larsen of La Réunion Island syndrome (B4GALT7-linkeropathy)

Larsen of La Réunion Island syndrome (LRS) is an autosomal recessive condition associated with multiple large joint dislocations, clubfeet, severe dwarfism, and distinctive facial features. LRS is caused by a recurrent homozygous variant in B4GALT7 gene with a founder effect in La Réunion population. Proteoglycans (PG) that are a major component of the extracellular matrix, are composed of a core protein connected to a glycosaminoglycans side chain via a tetrasaccharide linker region. B4GALT7 encodes galactosyltransferase I, one of the enzymes involved in the biosynthesis of the linker region. Conditions caused by pathogenic biallelic variants in genes implicated in the synthesis of the tetrasaccharide linker of PG are known as linkeropathies.Prenatal features are rarely described in this group of chondrodysplasias. We present a series of 12 unpublished patients having LRS and describe the perinatal phenotype. All the patients had a prenatal growth restriction with brevity of limbs. The other features revealed by ultrasounds were increased nuchal translucency at 10–12 weeks of gestation (50 %), feet abnormalities (clubfeet or metatarsus varus) (25 %), dislocation affecting at least one large joint (elbow, knee, wrist) (25 %). Bilateral bowing of femora was noted for two fetuses. Fibular hypertrophy was noted for one fetus. Prenatal helical computed tomography (CT) performed in three pregnancies showed additional data such as bowing of the forearm bones, proximal radio-ulnar synostosis, or dislocation of large joints. Prenatal sonographic and helical CT findings led to the prenatal diagnosis of LRS in four patients. We confirm that the neonatal clinical picture of LRS has an important overlap with that reported in patients with B4GALT7 deficiency outside La Réunion Island and other linkeropathies. The core of the phenotypic spectrum combines low birth height, micromelia, hypermobility, dislocation of at least one large joint, facial features with prominent eyes, microstomia, depressed nasal bridge, and midface hypoplasia. Other clinical features include clubfeet (33%), bifid thumb in one patient, and cardiac abnormalities in two patients. Radiological findings include radio-ulnar synostosis (75%), metaphyseal flaring, precocious carpal ossification, and a Swedish key appearance of the proximal femora. Finally, we also report radiological features rarely described in B4GALT7-linkeropathies, including bowing of the femora and fibular hypertrophy. Our results confirm the phenotypic continuum of LRS within linkeropathies with some additional findings, including a high frequency of clubfeet usually described in B3GALT6-linkeropathies, the presence of congenital heart diseases usually described in B3GAT3-linkeropathies, and a high frequency of metaphyseal flaring usually reported in B3GALT6 or XITLT1-linkeropathies.This is the first study that describes the perinatal phenotype in a cohort of patients with LRS. This study can help improve the prenatal diagnosis of the linkeropathies and add this group of conditions to the differential diagnosis of chondrodysplasias with multiple dislocations.In view of the founder effect for LRS in La Réunion Island, this disease should be suspected in fetuses with growth restriction and micromelia. Thus in case of LOH which include B4GALT7 identified in SNP-array, we recommend performing a targeted Sanger sequencing for the recurrent mutation c.808C > T; p. (Arg270Cys).

Patient and Caregiver Impressions of the Impact of Madelung Deformity: A CoULD Registry Analysis

This study seeks to investigate demographics of patients with Madelung deformity in a large, geographically diverse sample and understand patient and caregiver perceptions of the impact of this condition. We hypothesized that patients with untreated Madelung deformity have greater pain and lower function compared to the normal population but are less affected than the chosen control group, namely, patients with proximal radioulnar synostosis (PRUS). This retrospective study queried the Congenital Upper Limb Differences (CoULD) Registry, a multicenter registry of patients treated in tertiary care pediatric hospitals. We searched patients enrolled as of July 2022 and identified 3,980 total patients and 66 (1.7%) with a diagnosis of Madelung deformity. We reviewed demographics and Patient-Reported Outcomes Measurement Information System (PROMIS; peer relations, depressive symptoms, pain interference, and upper extremity function domains) scores at time of enrollment. We used a matched cohort comparison with propensity scoring for 50 patients with Madelung deformity and 50 patients with PRUS (control cohort). Patients with Madelung deformity presented at an average age of 13.1 years (± 2.1 years). Ninety-eight percent were female, and 82% were White. Seventy-four percent had distal radius-only deformity. Upper extremity PROMIS scores in both the Madelung deformity and the PRUS groups were significantly "worse" than normal, confirming our hypothesis. The Madelung deformity and PRUS cohort scores were not consistently different from one another. PROMIS scores from all other domains, including pain interference, were similar to, or better than normal for both groups, disproving the second part of our hypothesis. Patients with Madelung deformity averaged 13 years of age and were nearly all female, and the majority had only distal involvement of the radius. Patients with Madelung deformity had lower function based on PROMIS scores, similar to the control cohort, whereas all other PROMIS measures were similar to or better when compared to normal values. Pain interference scores in both cohorts were lower than normal values. Patients with Madelung deformity have decreased function, similar to the comparative cohort of patients with PRUS, but do not present with increased pain. Symptom prevalence III.

A novel missense mutation in the MECOM gene in a Chinese boy with radioulnar synostosis with amegakaryocytic thrombocytopenia

Radioulnar synostosis with amegakaryocytic thrombocytopenia (RUSAT) type 2, caused by MDS1 and EVI1 complex locus (MECOM) gene mutations, is a rare inherited bone marrow failure syndrome (IBMFS) with skeletal anomalies, characterized by varying presentation of congenital thrombocytopenia (progressing to pancytopenia), bilateral proximal radioulnar synostosis, and other skeletal abnormalities. Due to limited knowledge and heterogenous manifestations, clinical diagnosis of the disease is challenging. Here we reported a novel MECOM mutation in a Chinese boy with typical clinical features for RUSAT-2. Trio-based whole exome sequencing of buccal swab revealed a novel heterozygous missense mutation in exon 11 of the MECOM gene (chr3:168818673; NM_001105078.3:c.2285G > A). The results strongly suggest that the variant was a germline mutation and disease-causing mutation. The patient received matched unrelated donor hematopoetic stem cell transplantation (HSCT). This finding was not only expanded the pathogenic mutation spectrum of MECOM gene, but also provided key information for clinical diagnosis and treatment of RUSAT-2.

Congenital Bilateral Proximal Radio-Ulnar Synostosis in a Nigerian Child

Congenital Bilateral Proximal Radio-Ulnar Synostosis in a Nigerian Child

Congenital Radioulnar Synostosis – A Case Report

Congenital radio-ulnar synostosis (CRS) is a rare congenital disorder characterized by the fusion of the radius and ulna bones in the forearm. This results in a lack of mobility and flexibility in the forearm, and can cause functional limitations, including difficulty with grasping and holding objects. A 4-year-old child with pain and restricted mobility of the elbow joint was admitted to the hospital. Plain film radiography and CT examination was performed. Radiological examinations showed a congenital proximal radioulnar synostosis. Diagnostic imaging including computed tomography with three-dimentional (3D) reconstructions, preceding surgery enables planning of the surgical treatment.

Proximal radioulnar synostosis following Monteggia fracture-dislocation: a case report

Introduction and importance: Radioulnar synostosis is a rare complication of a forearm fracture that restricts pronation-supination. This study presents a case of proximal radioulnar synostosis in an adult male after Monteggia fracture-dislocation who had a loss of pronation and supination movements. Case presentation: Herein, we report a case of proximal radioulnar synostosis in a 43-year-old man who presented with loss of pronation and supination of the right forearm that restricted his daily activities. He had a history of Monteggia fracture-dislocation 9 months back, which was managed with open reduction and internal fixation with a dynamic compression plate. Plain radiography and computed tomography of the right forearm after 9 months of operation showed an implant in situ with proximal radioulnar synostosis. Implant removal was performed and the excess fibro-osseous connection in the proximal radius and ulna was removed. Clinical discussion: Forearm injuries that affect the interosseous membrane may result in radioulnar synostosis. Trauma and treatment-related factors increase the risk of radioulnar synostosis. The fibro-osseous fusion between the forearm bones restricts the pronation and supination movements. Conclusion: Loss of pronation-supination following forearm fracture should raise suspicion of radioulnar synostosis.

The Boyd approach: a valuable alternative to treating simple to complex elbow fractures and dislocations.

The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.

Congenital bilateral radioulnar synostosis: A rare case report with review of literature

Congenital radioulnar synostosis (CRUS) is a rare anomaly of the upper limb which causes varying degrees of limitations in forearm rotations. It most commonly presents at the age of 6 years when the child starts going to school with difficulty in day-to-day activities. A 5-year-old male child presented to the outpatient department with complains of difficulty in forearm supination bilaterally. Plain radiography showed proximal radioulnar synostosis of 5 cm on both sides. He was managed conservatively with physiotherapy, occupational therapy, activity modification, and counseled about following up if no improvement occurred, in 2 years. CRUS can present as an isolated anomaly and is easily missed as it usually does not cause significant cosmetic concern and the child learns to overcome the deficits in forearm movements by compensatory movements at the shoulder and distal radioulnar joint. Diagnostic imaging plays a major role in identifying and planning management.

Fibula flap in upper extremity segmental/critical size bone defects fixed with locking plates. Single-institution observational cohort

IntroductionManagement of bone defects in the upper extremity can vary depending on the size and location of the defect. Large defects may require complex reconstruction techniques. Vascularized bone grafts, mainly free vascularized fibula flap (FVFF), have many advantages in the treatment of bone or osteocutaneous defects. However, complications such as graft fracture are the most common, with a free fibula flap for bone defects in the upper extremity. This study aimed to describe the results and complications associated with the treatment of posttraumatic bone defects in the upper extremity using FVFF. We hypothesized that performing osteosynthesis using locking plates would prevent or reduce the fracture of the fibula flap Materials and methodsThis was a retrospective single-centre cohort study. Patients with segmental bone defects caused by trauma who underwent reconstructive surgery with FVFF fixed with locking compression plates (LCP) between January 2014 and 2022 were included. Demographic variables and preoperative data, such as bone defect, location, and time until reconstruction, were collected. Bone defects were classified according to the Testworth classification. Intraoperative variables included the length of the FVFF, type of graft (osteocutaneous or not), type and technique of arterial and venous sutures, number of veins used as output flow, and the osteosynthesis technique used. ResultsTen patients were included (six humerus, three ulna, and one radius). All patients had critical-size bone defects, and nine patients had a history of infection. In 9 of 10 patients, bone fixation was performed with a bridge LCP and in one patient with two LCP plates. In eight cases, the FVFF was osteocutaneous. All the patients showed bone healing at the end of the follow-up period. There was one early complication, donor site wound dehiscence, and two long-term complications (proximal radioulnar synostosis and soft-tissue defect). ConclusionA high rate of bone union with a low rate of complications can be obtained with an FVFF in upper extremity segmental/critical-size bone defects. Rigid fixation with locking plates avoids stress fractures of the grafts, mainly in humeral reconstruction. However, in these cases, a bridge plate should be used.

Type 4 congenital proximal radio-ulnar synostosis mimicking as malunited radial neck and deformed radial head with insidious onset extension block: a case report and results after excision

<p class="abstract">Proximal radio ulnar synostosis is a rare entity presenting with restriction of supination and pronation. Among the various types, type 4 variety is even more-rare and its presentation, can pose a diagnostic challenge specially, if with history of trauma. Radiologically, it is usually overlooked as a malunited radial neck and therefore needs thorough evaluation. We presented a case of a 15-year-old male who complains of new onset extension block following trauma, with chronically restricted supination and pronation. History suggested the restriction in supination and pronation since birth, and the extension block occurring de novo. Radiographs and CT scan of the elbow revealed proximal radio-ulnar synostosis and anteriorly dislocated, mushroom-shaped radial head, misleading and mimicking like an old, neglected and malunited radial neck fracture with a deformed radial head. The family insisted to not address the restriction of supination pronation but, asked for solution to more disabling extension block. Thus, patient was managed with open procedure, involving radial head-neck excision and removal of malformed radial head. At 1-year follow-up, the child has a well-reduced and stable elbow joint with a functional range of flexion and extension movements with restricted supination and pronation. Type 4 congenital radio ulnar synostosis not only leads to conventionally known restriction of supination pronation but also give rise to extension block de novo as presented in this case. Excision of the deformed head and neck can treat the restriction in extension, however the synostosis will require various other augmented procedures.</p>

Treatment of Congenital Radioulnar Synostosis Using a Free Vascularized Fascia Lata Graft.

ObjectiveTo describe the modified mobilization surgery technique that uses a free vascularized fascia lata graft as the interposition graft, and to evaluate the outcome of this procedure in treating congenital radioulnar synostosis (CRUS).MethodsEleven patients (eight boys and three girls with an average age of 6.0 years) were treated using this procedure between 2012 and 2017 in our institution. Five bilateral cases (four left forearms and one right forearm were treated), and six unilateral cases (three left forearms and three right forearms) were included. All 11 cases were treated with mobilization procedure with free vascularized fascia lata as the interposition graft, and were followed‐up for an average of 2.2 years (range, 2–4 years). The parental satisfaction, postoperative ankylosis at proximal radioulnar joint, and active range of forearm rotation motion (measured by physical examination) were evaluated at the last follow‐up.ResultsThe average preoperative fixed pronation angle was 67.3° (range, 20°–90°). Ipsilateral thumb hypoplasia was noted in one case, and cleft palate and bilateral thumb hypoplasia were noted in one case; none of the patients had a family history of congenital radioulnar synostosis. Pronation and supination splints were used 3 days after the operation and were worn every night for 4–6 months postoperatively. Active and passive rehabilitation for elbow flexion and forearm rotation was initiated 4 weeks postoperatively. All patients were followed up for at least 2 years (average, 26 months; range, 24–48 months). The average forearm pronation range was 39° (range, 20°–60°), and the average forearm supination range was 33.2° (range, 10°–60°) at the latest follow‐up. Re‐ankylosis occurred in one case. An osseous bridge developed between the radius and ulna at the osteotomy site in one case. Radial nerve paralysis developed in two cases and spontaneously resolved 2 months later. Plate breakage was noted in one case 9 weeks postoperatively; however, union was achieved 7 months later.ConclusionMobilization of proximal radioulnar synostosis using a free vascularized fascia lata graft as the interposition graft may prevent re‐ankylosis and restore the forearm rotation function, making it a good option for the surgical treatment of CRUS.

An anatomical classification of congenital proximal radioulnar synostosis based on retrospective MRI measurement combined with radiography

Existed classifications of congenital proximal radioulnar synostosis (PRUS) mainly focus on osseous changes and do not cover all types of congenital PRUS, ignoring the role and developing status of the supinator. This study aims to explore the correlation between supinator development and radiographic deformity of congenital PRUS. Pediatric patients diagnosed with congenital PRUS in two pediatric Orthopedic centers were evaluated retrospectively. MRI and radiographic images of their bilateral forearms (including normal ones) were collected. The area of supinator, extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), brachioradialis (BRAR) muscle and extensor indicis (EI) muscle were measured on each forearm. The ratios of these muscles were calculated and regarded as an indicator of the developing status of supinator muscle. Twenty-seven congenital PRUS forearms of 16 patients (average 3.45 years) were included. A new MRI & X-ray classification system was proposed to cover all types of radiographic deformity and provide a comprehensive description of supinator development. This study revealed the relation between MRI measured supinator volume and radiographic deformity of congenital PRUS. Supinator muscles were observed in all congenital PRUS cases. A novel classification was proposed, providing a more comprehensive understanding of congenital PRUS.

Derotational Osteotomy and Plate Fixation of the Radius and Ulna for the Treatment of Congenital Proximal Radioulnar Synostosis.

PurposeTo evaluate the clinical outcomes of derotational osteotomy followed by plate fixation at the radius and ulna for the treatment of congenital proximal radioulnar synostosis.MethodsA total of 10 eligible patients (12 forearms) with congenital proximal radioulnar synostosis were admitted to our institution from January 2013 to January 2016 and treated by radioulnar derotational osteotomy followed by plate fixation. There were 5 males and 5 females with an average age of 5.4 ± 2.0 (3–9) years old. The average forearm position was 56.67 ± 14.36° (range, 40°–80° pronation) in pronation before surgery. According to the classification system of Cleary and Omer, 3 forearms were categorized as type II, 7 as type III, and 2 as type IV. The pre- and postoperative forearm function was recorded and evaluated by the Failla scoring system.ResultsAll included patients were successfully followed up for an average time of 73.90 ± 8.24 months (range, 61–84 months). The mean achieved correction of the forearm was 53.33° ± 12.67° (range, 35°–70°). The average final position was 3.33° ± 14.98° (range, 20° of supination to 25° of pronation) in pronation. Bony union was achieved in a mean of 10.38 ± 1.25 weeks (range, 8.4–12.3 weeks) with no loss of correction. There were no incidences of nonunion, osteomyelitis, or neurologic or circulatory complications. The preoperative functional results were good in 1 forearm, fair in 8 forearms and poor in 3 forearms. In terms of final follow-up functional evaluations, 3 forearms were excellent, 6 forearms were good, and 3 forearms were fair.ConclusionsCongenital proximal radioulnar synostosis can be successfully treated using derotational osteotomy and plate fixation of the radius and ulna, which is an effective method with fewer postoperative complications and expected clinical outcomes.

Congenital Radioulnar Synostosis

Introduction: congenital radioulnar synostosis is an uncommon congenital anomaly, thatcauses a limitation of the forearm supination, often bilateral. The origin of this anomaly occurs when the differentiation of the cartilaginous contour of the radius and ulna does not take place during the embryonic period.
 Objective:to show two congenital radioulnar sinostosis cases analyzing variable about the topic.
 Case report:there are two different types of synostosis. In these cases the symptoms are mild because the compensate thein limitation in pronosupinationwith hypermobility of other joints of the upper limb. X-rays of upper limbs are the diagnostic procedures. The management will be conservative, but the treatment depends on the degree of functionality of the forearm.
 Conclusions:proximal radioulnarsynostosis is anon frequent affection, that brings about difficulties carrying out actions with the hands, Its diagnosis is relatively simple by means of the clinical findings andplain X-rays of the elbow.

Distal biceps ruptures repair: Experience with 80 cases

Introduction and objectivesRupture of distal biceps has a frequency of 1.2 cases per 100,000 population. Conservative treatment presents a loss in supination of 40% and flexion of 30%, like transfers to the brachialis. Our goal is to review our experience with anatomical reattachment. Material and methodsCohorts study. We analized an historic cohort, although recent, treated with double approach (Boyd-Anderson) compared to another prospective cohort (treated with single and double approach). Sample size of 80 patients. Mean age of 48.9 ± 5.9 years. We analyzed laterality, time to diagnosis, presurgery time, surgery time, approach, type of reintegration, rehabilitation time, Mayo Elbow Performance Score (MEPS), biomechanical study and complications. Follow up from 2 years to 7 years. ResultsTime for diagnosis was about 4 days. Preoperative time: 12.2 ± 6.4 days. Surgical time: 61.9 ± 15.7 min. We used the two-way surgical approach (Boyd-Anderson-Morrey) in 78.8% of patients, and the anterior surgical approach (Henry) in 21.2% of cases. Transosseous reinsertion was made in 45% of cases, with screw anchor in 40% and with cortical button in 15%. Rehabilitation time: 91 ± 29.7 days. MEPS: 88 ± 11.7 points. There was loss of flexor strength of 28 ± 16.6%. Complications: 1 case of proximal radioulnar synostosis, 2 radial transient paralysis and 5 cases with residual stiffness. Hypothesis contrast: We reached best results in MEPS with double surgical approach (P = .009), with fewer complications (P = .008). We observed increased pain with cortical buttons (P < .05) and less surgical time if patient was operated before 1 week (P = .03). Relative risk of 0.2 when we compared type of approach with radial nerve lesion risk, considering that double approach had less cases, what it would be consider as a protective factor. ConclusionsIn our experience, we believe that anatomic reattachment is an effective treatment. Double surgical approach presents best result in MEPS, with fewer complications than with anterior approach.

Hand and Upper Limb Malformations in Italy: A Multicentric Study.

Background: Although hand and upper limb malformations are quite frequent, up to now very few reports have been published on epidemiology. The aim of this study is to evaluate the number of infants who presented with hand and upper limb malformations from 2010 to 2015 in Italy. Methods: A retrospective analysis of a pediatric population presenting with hand and upper extremity malformations was carried out, gathering reports achieved from eight Italian Centers of pediatric hand surgery. Other factors such as gender, date and region of birth, family distribution of malformations and associated syndromes, were analysed. Results: Out of 3,100,421 live births, 765 children presented with hand and upper limb malformations. The incidence was 2,5/10,000 live births with a predominance of males and the right side. Radial polydactyly was the anomaly with the highest percentage, closely followed by simple syndactyly, simbrachidactyly and complex syndactyly. Less common conditions were the triphalangic thumb, thumb in palm, proximal radioulnar synostosis and Sprengel deformity. Inheritance of and familial predisposition to those malformations was recorded in 25 cases, while 84 children presented with syndromes related to hand anomalies. Conclusions: In conclusion the incidence of hand and upper extremity malformations in Italy is lower than that registered in other countries. The retrospective nature of the study combined with the fact that some defects frequently evade pediatric hand surgeon consultations are some possible limitations of the study. However, our data confirmed that, in spite of the decrease in the birth rate in Italy, the trend of congenital hand disorders maintained a stable trend. We aim to integrate this study with a prospective analysis and to involve the institutional health authorities in other countries so as to register the correct incidence of hand and upper extremity defects.

Congenital Radioulnar Synostosis

Introduction: congenital radioulnar synostosis is an uncommon congenital anomaly, that causes a limitation of the forearm supination, often bilateral. The origin of this anomaly occurs when the differentiation of the cartilaginous contour of the radius and ulna does not take place during the embryonic period. Objective: to show two congenital radioulnar synostosis cases analyzing variable about the topic. Case report: there are two different types of synostosis. In these cases the symptoms are mild because the compensate thein limitation in pronosupination with hypermobility of other joints of the upper limb. X-rays of upper limbs are the diagnostic procedures. The management will be conservative, but the treatment depends on the degree of functionality of the forearm. Conclusions: proximal radioulnar synostosis is a non frequent affection, that brings about difficulties carrying out actions with the hands, Its diagnosis is relatively simple by means of the clinical findings andplain X-rays of the elbow.

Reparación de roturas de bíceps distal, experiencia a propósito de 80 casos

Introduction and objectivesRupture of distal biceps has a frequency of 1.2 cases per 100,000 population. Conservative treatment presents a loss in supination of 40% and flexion of 30%, like transfers to the brachialis. Our goal is to review our experience with anatomical reattachment. Material and methodsCohorts study. We analized an historic cohort, although recent, treated with double approach (Boyd-Anderson) compared to another prospective cohort (treated with single and double approach). Sample size of 80 patients. Mean age of 48.9±5.9years. We analyzed laterality, time to diagnosis, presurgery time, surgery time, approach, type of reintegration, rehabilitation time, Mayo Elbow Performance Score (MEPS), biomechanical study and complications. Follow up from 2 years to 7years. ResultsTime for diagnosis was about 4days. Preoperative time: 12.2±6.4 days. Surgical time: 61.9±15.7minutes. We used the two-way surgical approach (Boyd-Anderson-Morrey) in 78.8% of patients, and the anterior surgical approach (Henry) in 21.2% of cases. Transosseous reinsertion was made in 45% of cases, with screw anchor in 40% and with cortical button in 15%. Rehabilitation time: 91±29.7 days. MEPS: 88±11.7 points. There was loss of flexor strength of 28±16.6%. Complications: 1case of proximal radioulnar synostosis, 2 radial transient paralysis and 5 cases with residual stiffness. Hypothesis contrast: We reached best results in MEPS with double surgical approach (P=.009), with fewer complications (P=.008). We observed increased pain with cortical buttons (P<.05) and less surgical time if patient was operated before 1week (P=.03). Relative risk of 0.2 when we compared type of approach with radial nerve lesion risk, considering that double approach had less cases, what it would be consider as a protective factor. ConclusionsIn our experience, we believe that anatomic reattachment is an effective treatment. Double surgical approach presents best result in MEPS, with fewer complications than with anterior approach.

Measurement of compensatory wrist joint rotation using three-dimensional motion analysis in patients with unilateral proximal congenital radioulnar synostosis.

This study aims to investigate compensatory rotational movements of the wrist joint in patients with proximal congenital radioulnar synostosis (CRUS), using a valid and reliable three-dimensional (3D) motion analysis technique. A total of 26 patients (6 females, 14 males; mean age=15.3 years; and age range=6-32 years) who were diagnosed with unilateral proximal CRUS but were not operated were enrolled in this study. Patients were then categorized into 2 groups: Group I included 5 patients younger than 10 years, and Group II included 15 patients older than 10 years. Eighteen light-reflective skin markers were placed on the bony landmarks of both upper limbs, and both distal forearms were fixed using a U-shaped device to minimize forearm rotation. Each patient grasped the handle of an instrument that used a goniometer to measure wrist rotation; maximal passive pronation and supination angles of the wrist were measured in this manner and also using 3D motion analysis. There was a significant correlation between measurements by the goniometer and 3D motion analysis (r=0.985, p<0.001). The test-retest reliability of the 3D motion analysis was acceptable for both the affected side (ICC=0.992) and the contralateral normal side (ICC=0.997) with low standard measurement errors (1.3° and 0.8°, respectively). Although no significant difference was observed in the range of the wrist rotation between the affected and contralateral sides in Group I (p=0.686), there was a significant difference in the wrist rotation between the affected and contralateral sides in Group II (p=0.001). Further, the pronation angle of the wrist joint was significantly larger in the affected side than that in the contralateral normal side in Group II (p=0.001). The 3D motion analysis technique seems to be a valid and reliable method to measure the rotation of the wrist joint. Unilateral proximal CRUS patients older than 10 years of age may develop rotational hypermobility of the wrist joint compared to the contralateral normal side as a compensatory phenomenon. Level III, Diagnostic Study.