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

Li, Jin; Chen, Kailei; Wang, Jing; Guo, Yunfei; Rai, Saroj; Tang, Xin

doi:10.1038/s41598-022-09411-6

Cited by 4 publications

(9 citation statements)

References 33 publications

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“…Patients in type II and IV demonstrated similar pronation ankylosis degrees without chronological relevance. In this study, the manifestation of C&O II and IV was similar in age and ankylosis pronation severity, which corroborated the fusion of C&O classification II and IV as CMPOS type II (12).…”

Section: Discussionsupporting

confidence: 85%

“…Li Jin et al confirmed the presence of supinator in all patients with CRUS in their study (12). However, the novel CMPOS classification is still an anatomical and radiographic classification without direct reflection of the forearm functional restriction (12). Patients in type II and IV demonstrated similar pronation ankylosis degrees without chronological relevance.…”

Section: Discussionmentioning

confidence: 83%

“…C&O classification is widely adopted in academic publications, but it did not reflect the severity of deformity regarding the forearm functional restriction (11). Li Jin et al confirmed the presence of supinator in all patients with CRUS in their study (12). However, the novel CMPOS classification is still an anatomical and radiographic classification without direct reflection of the forearm functional restriction (12).…”

Section: Discussionmentioning

confidence: 98%

“…However, because of the small cohort, the relation between C&O classification and clinical manifestation was not revealed clearly (11). In the past, supinator was thought to be absent in certain patients, which was repudiated by Li Jin et al (12). Recently, a novel classification system based on x-ray and magnetic resonance imaging (MRI) was proposed by Chinese Multi-center Pediatric Orthopedic Study Group (CMPOS) (12).…”

Section: Introductionmentioning

confidence: 99%

“…In the past, supinator was thought to be absent in certain patients, which was repudiated by Li Jin et al (12). Recently, a novel classification system based on x-ray and magnetic resonance imaging (MRI) was proposed by Chinese Multi-center Pediatric Orthopedic Study Group (CMPOS) (12). The supinator was taken into consideration in this novel anatomical classification and all patients demonstrated the presence of supinator in the MRI.…”

Section: Introductionmentioning

confidence: 99%

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The relation between radiographic manifestation and clinical characteristics of congenital radioulnar synostosis in children: A retrospective study from multiple centers

Pan

Tan²,

Zhou³

et al. 2023

Front. Pediatr.

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ObjectiveTo review the radiographic manifestation and clinical appearance of children with congenital radioulnar synostosis (CRUS) retrospectively.Study designRetrospective cohort study of children with CRUS from multiple medical centers.ResultsA total of 329 patients (male 259, female 70) with an average age of 5.4 years (0.5–16 years old), were included in this study. In particular, 145 patients (145/329, 44.1%) demonstrated bilateral involvement, and 184 patients (left 123, right 61) demonstrated unilateral involvement. As for Clear and Omery (C&O) classification, most patients belonged to Type III, and then followed by Type IV. As for Chinese Multi-center Pediatric Orthopedic Study Group (CMPOS) classification, most patients belonged to Type III, and then followed by Type II and Type I. In C&O Type III, 92.03% patients demonstrated severe pronation. According to CMPOS classification, 92.98% Type I patients demonstrated neutral to mild pronation, 72.17% Type II patients demonstrated moderate pronation, and 92.03% Type III patients demonstrated severe pronation. The age distribution showed no significant difference between C&O Type II and IV (P = 0.96); the pronation ankylosis severity showed no significant difference between C&O Type II and IV (P = 0.387).ConclusionAlthough CRUS is a rare forearm deformity, there are certain relation between radiographic manifestation and clinical forearm functional restriction. CRUS patients of C&O or CMPOS Type III classification might suffer severe pronation deformity and warrant early intervention.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The relation between radiographic manifestation and clinical characteristics of congenital radioulnar synostosis in children: A retrospective study from multiple centers

Pan

Tan²,

Zhou³

et al. 2023

Front. Pediatr.

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Clinical and radiological aspects of the forearm in children with congenital radioulnar synostosis: a cohort study

Fedorova,

Vissarionov,

Proshchenko

et al. 2024

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Introduction The upper limb functional limitations in congenital radioulnar synostosis may significantly affect the daily activities of patients. Classifications of the condition are descriptive and have limited practical application.Purpose Determine a functionally significant quantitative criterion for anatomical changes in the forearm.Material and methods 92 children (136 forearms) with congenital radioulnar synostosis were examined for limitations in activities of daily living (ADL), health-related quality of life measured with PedsQL questionnaire; pronation of the forearm and radiographic parameters. A comparative and correlation analysis, ROC analysis were performed to determine the relationship between the forearm pronation and limitations of ADL.Results Statistically significant correlations were revealed between symptoms and the forearm alignment (p < 0.01, rxy = 0.5); subluxation of the ulnar head and forearm alignment (p < 0.001, rxy = 0.6); bowing deformity of the radius, forearm alignment and subluxation of the ulnar head and between the length of the forearm bones and bowing deformity of the radius (p < 0.05, rxy = 0.4 and rxy = 0.5). A statistically significant inverse correlation was revealed between symptoms and PedsQL scores (p = 0.038, rxy = –0.4). Pronation of 45° was the threshold value of the forearm alignment with a high risk of ADL limitation. The area under the ROC curve corresponding to the relationship between symptoms and the forearm alignment was 0.955 ± 0.021 (95 % CI: 0.915–0.995). There was a statistically significant (p < 0.01) decrease in the lumen of the medullary canal in the middle third of the ulnar shaft with the radius lumen being unchanged. Dorsal subluxation of the ulnar head was detected In 30 % of cases.Discussion The characteristics identified demonstrated changes in the forearm bones with functional impairments being correlated with the forearm pronation.Conclusion The correlation between the patient’s symptoms and the forearm alignment must be taken into account in the classification and when determining indications for surgical treatment distinguishing between functional (< 45° pronation) and dysfunctional (≥ 45° pronation) options.

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Congenital Proximal Radioulnar Synostosis in an Elite Athlete–Case Report

et al. 2023

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Background and Objectives: Proximal radioulnar synostosis (PRUS) is the most frequent congenital forearm disorder, although the prevalence in the general population is rare with a few hundred cases reported. Pfeiffer, Poland, Holt–Oram, and other serious congenital syndromes contain this abnormality. Non-syndromic cases with isolated PRUS very often exhibit as SMAD6, NOG genes variants, or sex chromosome aneuploidy. A subgroup of patients with haematological abnormalities presents with HOXA11 or MECOM genes variants. Case report: We present a non-syndromic adult elite ice-hockey player with unilateral proximal radioulnar synostosis of the left forearm. In early childhood he was able to handle the hockey stick only as a right-handed player and the diagnosis was set later at the age of 8 years due to lack of supination. Cleary–Omer Type III PRUS was found on x-ray with radial head hypoplasia and mild osteophytic degenerative changes of humeroulnar joint. Since the condition had minimal impact on sports activities, surgical intervention was not considered. The player continued his ice-hockey career at the top level and joined a national team for top tournaments. Upper extremity function assessment with questionnaires and physical testing resulted in minimal impairment. The most compromised tool was the Failla score with 10 points from a total of 15. Genetic testing with Sanger sequencing revealed no significant pathogenic variant in SMAD6, NOG, and GDP5 genes. No potentially pathogenic copy number variants were detected by array-based comparative genomic hybridization. Conclusions: In the reported case, the ability of an athlete to deal with an anatomic variant limiting the forearm supination is demonstrated. Nowadays, a comprehensive approach to rule out more complex musculoskeletal impairment and family burden is made possible by evolving genetics.

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

Cited by 4 publications

References 33 publications

The relation between radiographic manifestation and clinical characteristics of congenital radioulnar synostosis in children: A retrospective study from multiple centers

The relation between radiographic manifestation and clinical characteristics of congenital radioulnar synostosis in children: A retrospective study from multiple centers

Clinical and radiological aspects of the forearm in children with congenital radioulnar synostosis: a cohort study

Congenital Proximal Radioulnar Synostosis in an Elite Athlete–Case Report

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