Summary
Objectives
Resection of a posttraumatic proximal radioulnar synostosis to gain pronation and supination of the forearm.
Indications
Posttraumatic proximal radioulnar synostosis. Resection can be performed relatively early.
Contraindications
Central nervous system injury constitutes a relative contraindication.
Surgical Technique
Posterior midline incision which can be extended proximally if exposure of the entire elbow is needed. Dissection and exposure of the proximal and distal ends of synostosis while protecting the surrounding soft tissue. Resection of the exostosis. Test range of passive rotation. Cauterization of bleeding bony surfaces and coverage with bone wax. No need for interpositional material.
Results
A consecutive series of 17 patients with 18 synostoses has been reviewed. Resection was performed between 6 and 11 months post injury. Average follow-up: 32 months. One patient, who had sustained a closed head trauma, suffered a recurrence. The average supination gain was 61° (25° to 85°) and the gain in pronation amounted to 78° (40° to 90°). Using the classification system of Failla et al., the overall results were judged excellent in 16 limbs, fair in 1 and poor in 1.
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References
Abrams RA, Simone BP, Brown RA, Botte MJ. Treatment of radioulnar synostosis with excision and low-dose radiation. J Hand Surg [Am] 1993;18:703–7.
Ayers DC, Evarts CM, Parkinson JR. The prevention of heterotopic ossification in high risk patients by low-dose radiation therapy after total hip arthroplasty. J Bone Joint Surg [Am] 1986;68:1423–30.
Botting TDJ. Post-traumatic radioulnar cross-union. J Trauma 1970;10:16–24.
Boyd HB. Surgical exposure of the ulna and proximal third of the radius through one incision. Surg Gynecol Obstet 1940;71:86–8.
Brady LP, Jewett EL. A new treatment of radioulnar synostosis. South Med J 1960;53:507–12.
Breit R. Post-traumatic radioulnar synostosis. Clin Orthop 1983;174:149–52.
Corless JR. Post-traumatic radioulnar synostosis. J Bone Joint Surg [Br] 1977;59:510.
Cullen JP, Pellegrini VD, Miller RJ, Jones JA. Treatment of traumatic radioulnar synostosis by excision and post-operative low-dose irradiation. J Hand Surg [Am] 1994;19:394–401.
Dowdy PA, Bain GI, King GJW, Patterson SD. The midline posterior elbow incision. J Bone Joint Surg [Br] 1995;77:696–9.
Failla JM, Amadio PC, Morrey BF. Post-traumatic proximal radioulnar synostosis. J Bone Joint Surg [Am] 1989;71:1208–13.
Fielding JW. Radioulnar crossed union following displacement of the proximal radial epiphysis: a case report. J Bone Joint Surg [Am] 1964;46:1277–8.
Freitag P, Head JR, Lim HM. Radioulnar synostosis following trauma. Review of the literature and report of a case. Orthop Trans 1981;5:42–3.
Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop 1991;263:13–29.
Jupiter JB. Heterotopic ossification about the elbow. Instr Course Lect 1991;46:41–4.
Jupiter JB, Ring D. The operative treatment of proximal radioulnar synostosis. J Bone Joint Surg [Am] 1998;80:248–57.
Kapandji IA. The physiology of the joints. New York: Churchill Livingstone, 1982.
Kelikian H, Doumaninan A. Swivel for proximal radioulnar synostosis. J Bone Joint Surg [Am] 1957;39:945–52.
Konski A, Pelligrini V, Poulter C. Randomized trial comparing dose versus fractionated irradiation for prevention of heterotopic bone: a preliminary report. Int J Radiat Oncol Biol Phys 1990;18:1139–45.
Maempel FZ. Post-traumatic radioulnar synostosis. A report of two cases. Clin Orthop 1984;186:182–5.
Moddaber R, Jupiter JB. Current concepts: the management of the stiff elbow. J Bone Joint Surg [Am] 1995;77:1431–7.
Orzel JA, Rudd TG. Heterotopic bone formation: clinical, laboratory, and imaging correlation. J Nucl Med 1985;26:1125–32.
Patterson SD, King GJ, Bain GI. A posterior global approach to the elbow. J Bone Joint Surg [Br] 1995;77:Suppl III:316.abstract.
Sachar K, Akelman E, Ehrlich MG. Radioulnar synostosis. Hand Clin 1994;10:399–404.
Thurston AJ, Spry NA. Post-traumatic radioulnar synostosis treated by surgical excision and adjunctive radiotherapy. Aust N Z J Surg 1993;63:976–80.
Tooms RE. Complications of treatment of injuries to the forearm. In: Epps CH. ed. Complications in orthopaedic surgery. Philadelphia: Lippincott, 1986:325–38.
Vince KG, Miller JE: Cross-union complicating fracture of the forearm. Part I. J Bone Joint surg [Am] 1987;69:640–53.
Watson F, Eaton R. Post-traumatic radioulnar synostosis. J Trauma 1970;10:16–24.
Yong-Hing K, Tchang SPK. Traumatic radioulnar synostosis treated by excision and a free fat transplant. A report of two cases. J Bone Joint Surg [Br] 1983;65:433–5.
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Ring, D., Jupiter, J.B. Posttraumatic proximal radioulnar synostosis: Technique for operative resection. Orthop Traumatol 8, 239–249 (2000). https://doi.org/10.1007/BF03181106
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DOI: https://doi.org/10.1007/BF03181106