BackgroundThe primary objective of this review is to estimate the rotational correction after corrective derotation osteotomies (CDO) for Congenital radioulnar synostosis (CRUS). The secondary objective of this review is to identify the complications with CDO in CRUS, MethodsWe included studies in the English literature from electronic bibliographic databases Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Directory of Open access journals (DOAJ), EMBASE, MEDLINE, ProQuest, PubMed, and Scopus up to December 2020 that determined the effects of CDO in CRUS for two or more cases with a mean follow-up of 1 year or more. We used the National Institutes of health quality assessment tool for case series (interventional) and Modi ed Coleman methodology Score for assessment of Risk of bias in the included studies. ResultsWe pooled 383 forearms (318 participants) from 23 studies with mean age of 6.28±1.75 years. The mean pronation deformity was 72.83±15.64 0 from 22 studies. The CDO derotated forearm to 10.4±5.90 0 of mean pronation in 12 studies and 13.47±9.51 0 of mean supination in 9 studies. One study corrected the forearms to a neutral position. The mean derotation from CDO was 73.13±16.54 0 (35 0 supination to 130 0 pronation). The overall mean difference was -68.26 0 [95% ] of correction favouring supination. There were eight transient nerve palsies and six compartment syndromes from synostosis site osteotomies (4 studies). DiscussionWe had poor-quality studies at a High Risk of bias on the described tools of assessment. We could estimate the directional effect of CDO in CRUS favouring correction from pronation to supination; however, due to the heterogeneity among studies, we cannot comment on the most e cient and least harmful CDO techniques. The single bone osteotomies seem to be e cient, simple, and reportedly low on complications but need evaluation. We cannot de ne the indications for correction and expected improvement in functional outcomes from osteotomy techniques.

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Osteochondroma arising from the tibial tuberosity is very rare. We report such a case which mimicked OsgoodSchlatter’s disease in an adolescent. A 12 years-old boy presented with swelling over his right proximal tibia of one year duration associated with pain in the last three months. Examination revealed a 4 x 2cm bony mass arising from the proximal tibia. Radiographs revealed an osteochondroma of the tibial tuberosity. Computer tomography and magnetic resonance imaging confirmed the continuity of the medulla of the bony mass to that of the parent bone. Excision biopsy was done. At the final follow up, he was asymptomatic and returned back to his daily activities. We present this case for its rarity, challenges involved in diagnosis and the difficulties encountered in planning the surgery because of involvement of the apophysis and extensor mechanism attachment in a skeletally immature boy.

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