Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis

Abstract

Objective To evaluate the clinical and functional results of a technical procedure in the surgical treatment of congenital radioulnar synostosis in children. Materials and methods A prospective study had been undertaken from January 1992 to December 2004. Thirty-four patients with congenital radioulnar synostosis that are fixed in pronation were recruited. Congenital radioulnar synostosis was classified for two types according to Tachdjian’s criteria. All patients were treated by resection of the proximal radius and the distal ulna to remove a segmental bone of both parts of the forearm. After K-wires are inserted intramedullarly into both bones, the forearm is derotated manually, followed by cast immobilization. Results There were 34 patients (52 forearms) with congenital radioulnar synostosis, whom the average age at surgery was 6 years and 3 months. There were two types of congenital radioulnar synostosis: Type 1 in six forearms (11.6%) and Type 2 in 46 forearms (88.4%). The preoperative forearm rotation ranged from 65° to 85° pronation. The postoperative forearm rotation angle was corrected from 0° to 30°; the best end position appears to be 70–100% of pronation. Of the patients, 78.8% had good or excellent results. All patients were operated on without complications; five patients had loss of correction during cast immobilization. Overall, the patient’s ability to perform daily activities showed a marked improvement after surgery. Conclusion This method is a simple and safe technique to derotate the forearms of patients with congenital radioulnar synostosis that are fixed in pronation.