Treatment Of Proximal Radioulnar Synostosis Research Articles

The reverse Sauvé-Kapandji procedure for the treatment of (posttraumatic) proximal radioulnar synostosis

Proximal radioulnar synostosis is a rare but highly disabling posttraumatic complication in periarticular elbow injuries. Surgical treatment is an option for functionally limiting proximal radioulnar synostosis; however, the approach can endanger local neurovascular structures, especially if the synostosis affects the level of the bicipital tuberosity. We report two cases of proximal radioulnar synostosis with a preoperative prono-supination range of motion of 0° and 15° treated by a reverse Sauvé-Kapandji procedure resecting a 1-cm section of the radial shaft distal to the bicipital tuberosity and leaving the synostosis in place. An improvement in prono-supination arc of motion of 82.5° was achieved at 2years of follow-up with no complications associated with the technique. The reverse Sauvé-Kapandji procedure could be an option in the treatment of proximal radioulnar synostosis in selected cases.

Surgical outcome of delayed presentation of congenital proximal radioulnar synostosis.

Background: Presentation of proximal radioulnar synostosis varies from cosmetic concerns with no functional limitations to significant pronation deformity which hampers activities of daily living. Surgical management must be considered based on the position of the forearm and functional limitations. We describe the surgical technique, results, and complications of excision of the radial head along with the proximal radius up to the distal extent of the synostosis site and securing the osteotomized radial shaft with a tensor fascia lata graft. Materials and methods: Four patients having six affected elbows with delayed presentation of congenital proximal radioulnar synostosis with dislocated radial head managed surgically were included in the study. There were three males and one female with an average age of 20.25 years (ranging from 16 to 25 years). Preoperatively wrists were locked in the mean pronation position of 51.6° (ranging from 30° to 70°). The indications for surgery were limitation in activities of daily living and an obvious cosmetic deformity. Results: All patients were satisfied with the surgery and showed significant improvement in functional status. Mean active supination was 15° (ranging from 5 to 32°) with passive supination was a mean of 24.8° (ranging from 11° to 44°). Similarly, mean active pronation was 58.5° (ranging from 50° to 71°) with further passive correction up to a mean of 64.16° (ranging from 57° to 87°) at last follow up. Conclusions: This procedure is simple, cost effective, and a reasonable option for treatment of proximal radioulnar synostosis with a dislocated radial head in adult patients. The operation does not require any specialized team or implants, and can be performed in a moderately equipped hospital.

Is there any reality to the reverse kapandji operation In the treatment of proximal radioulnar synostosis? Biomechanical measurements

Is there any reality to the reverse kapandji operation In the treatment of proximal radioulnar synostosis? Biomechanical measurements

Is there any reality to the reverse Kapandji operation in the treatment of proximal radioulnar synostosis? Biomechanical measurements

The forearm, wrist and elbow joints in addition to the ligamentous system which holds the two bones together make up a combined joint with complex movement. Within this joint framework, injury at any point can result in profound biomechanical changes leading to functional alterations. Such an alteration is the bony bridge between the radius and ulna which is blocking the rotational movements. Surgical treatment can be instead of the resection of the bridge-callus creating a defect on the radius distally to the synostosis. This leads to a “reverse” Sauve–Kapandji situation and to the disintegration of the bony frame of the forearm. The authors examined the stabilizing effect of the ligamentous system which holds the framework together, with emphasis on the role of the interosseous membrane. Measurements of rotational motion in various stages in the forearm were performed on fresh cadaver forearm preparations in both intact cases and also following the excision of a proximal segment of the radius. The movements were measured and registered using an Instron 8874 biomechanical material testing machine. In addition to registration, both fi xed and mobile digital recording was done. The stabilizing role of the interosseous membrane in supination was only effective when the radius was of normal length. The excision of the radial segment seriously damaged both the rotational motion and the stability of the wrist. DOI: 10.17489/biohun/2010/2/05

Proximal radial resection for posttraumatic radioulnar synostosis: a new technique to improve forearm rotation.

Heterotopic ossification about the elbow joint can lead to considerable functional disability, including the loss of forearm rotation. Many procedures have been described for the treatment of proximal radioulnar synostosis. Varying degrees of success have been achieved with regard to the improvement of the flexion arc, but less success has been reported in terms of the restoration of forearm rotation. The success of treatment is associated with the extent of heterotopic ossification, soft-tissue scarring, and anatomical distortion. A new and simple technique to address the unresectable proximal radioulnar synostosis is described. Seven patients were managed with a partial proximal radial resection distal to the synostosis and were followed for an average of eighty months (range, twenty-four to 144 months). Forearm rotation improved from an average fixed pronation of 5 degrees to an average arc of 98 degrees (range, 40 degrees to 175 degrees ). The average functional score improved from 57 points preoperatively to 81 points at the time of the final review. Complications included reankylosis at the site of the resection and ulnar-nerve sensory neurapraxia in one patient each. Resection of a 1-cm-thick section of the proximal part of the radial shaft provides a safe and reliable method of improving forearm rotation in patients with heterotopic ossification of the elbow. A single technical factor that seems to positively influence the result is the application of bone wax at the resection site. This simple procedure is ideally suited for patients who have a proximal radioulnar synostosis that (1) is too extensive to allow a safe and discrete resection, (2) involves the articular surface, and (3) is associated with an anatomical deformity.