Modified osteotomy (Kanaya’s procedure) for congenital proximal radioulnar synostosis with posterior dislocation of radial head

Sakamoto, Sotetsu; Doi, Kazuteru; Hattori, Yasunori; Dodakundi, Chaitanya; Montales, Tristram D.

doi:10.1177/1753193413493386

Cited by 21 publications

(27 citation statements)

References 13 publications

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“…Surgical intervention is recommended by most surgeons when the loss of forearm rotation causes the patient to complain of functional difficulties. To date, two types of surgical treatments have been described: mobilization of the synostosis (Funakoshi et al, 2004;Jones et al, 2004;Kanaya and Ibaraki, 1998;Kao et al, 2005;Sakamoto et al, 2014), which frequently results in recurrence of the ankylosis with unsatisfactory results (Kanaya and Ibaraki, 1998;Miura et al, 1984;Sachar et al, 1994); and rotational osteotomy, which provides functional improvement (El-Adl, 2007;Griffet et al, 1986;Horii et al, 2014;Hung, 2008;Lin et al, 1995;Ogino and Hikino, 1987;Ramachandran et al, 2005;Shingade et al, 2014;Simmons et al, 1983). Therefore, rotational osteotomy is the accepted treatment for congenital radioulnar synostosis.…”

Section: Introductionmentioning

confidence: 99%

One-stage rotational osteotomy for congenital radioulnar synostosis

Hwang

Kim

Lee

et al. 2015

J Hand Surg Eur Vol

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We report the results of a one-stage rotational osteotomy of the proximal third of the ulna and distal third of the radius with segmental bone resection for treating congenital radioulnar synostosis. We retrospectively reviewed 25 patients (28 forearms) treated by operation. Patients were divided into two groups according to the method of internal fixation at the osteotomy sites. In Group 1 the ulnar osteotomy was stabilized with an intramedullary pin and in Group 2 no fixation was used. The average forearm position improved from 47° pronation before surgery, to 27° supination after surgery. There were no statistically significant differences between the two groups in surgical outcomes. One-stage rotational osteotomy of the proximal third of the ulna and distal third of the radius with segmental bone resection is a simple and safe treatment for patients with congenital radioulnar synostosis. Internal fixation at the osteotomy site seems to be unnecessary. Level of evidence: Level 4.

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Section: Introductionmentioning

confidence: 99%

One-stage rotational osteotomy for congenital radioulnar synostosis

Hwang

Kim

Lee

et al. 2015

J Hand Surg Eur Vol

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“…The postoperative range of pronation and supination in motion-preserving techniques has eventually been assessed in three studies [ 9 , 23 , 24 ]. The mean fixed deformity noted in supination and pronation was 16.1° (25° to neutral) and 40° (neutral to 80°), respectively.…”

Section: Resultsmentioning

confidence: 99%

Results after treatment of congenital radioulnar synostosis: a systematic review and pooled data analysis

Barik

Farr

Gallone

et al. 2020

Journal of Pediatric Orthopaedics B

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Congenital radioulnar synostosis (CRUS) is one of the most common congenital disorders affecting the elbow and forearm, with the forearm being fixed in a range of positions usually varying from neutral rotation to severe pronation. The aim of this study, apart from a systematic review of all surgical procedures described for CRUS, is to derive any correlation between various influencing factors, outcomes and complications. This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format by an electronic literature search of Ovid , MEDLINE and the Cochrane Library databases. Grading was according to the Newcastle-Ottawa scale and the Modified Coleman Methodology Score. Demographic data, surgical procedures, outcomes and complications were analyzed. Outcome data were pooled to establish means and ranges across all studies. Spearman correlations were performed. A total of 23 articles, showing a poor overall study quality (all Level of Evidence IV), met the inclusion criteria. A total of 374 forearms with a mean age of 6.7 years (2.0–18.8) were analyzed. Derotational surgeries were more commonly performed (91%) than motion-preserving surgeries (9%). The mean deformity improved from 64.8° pronation (−75° to 110°) to a mean of 2.8° pronation (−50° to 80°). In total, 17.9% of patients presented with complications. A significant correlation was noted between age and major complications, proximal osteotomies and complications, and postoperative loss of reduction and double level osteotomies as the primary treatment modality. Most of the complications occurred above the threshold of 65–70° of correction and in children 7 years and above. Surgery is essential to improve the quality of life of children with CRUS. However, each type of surgery is associated with complications, along with the respective hardware being used in rotation osteotomies. Caution is, nevertheless, warranted in interpreting these results in view of the inherent limitations of the included studies.

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“…Oka et al (2006) reported that postoperative range of motion (ROM) was limited and the axis of rotation was displaced from its normal location in cases with dislocation of the radial head on 3D motion analysis. Sakamoto et al (2014) found that the radial shaft in forearms with posterior dislocation had one abnormal curvature and that corrective osteotomy of the central part of the radius improved ROM.…”

Section: Discussionmentioning

confidence: 97%

“…The radius and ulna showed a large tendency to have internal rotation deformities, not seen on plain radiographs. Several authors have reported that the outcome of separation and mobilization surgery is unsatisfactory in patients with severe pronation ankylosis and posterior dislocation of the radial head (Kanaya and Ibaraki, 1998; Kinjo et al., 2008; Oka et al., 2006; Sakamoto et al., 2014). They reported that the forearm rotation was limited and the centre of the rotation arc was biased toward pronation in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…The wrist has very limited rotation and the forearm is usually fixed in neutral or pronation (Cleary and Omer, 1985). Pronation ankylosis of more than 60° is an indication for corrective surgery for these patients to improve function of the forearm (Funakoshi et al., 2004; Green and Mital, 1979; Hwang et al., 2015; Kanaya and Ibaraki, 1998; Kao et al., 2005; Kinjo et al., 2008; Sakamoto et al., 2014; Simmons et al., 1983). Postoperative rotation remains insufficient in cases with severe osseous pronation ankylosis and in cases with posterior dislocation of the radial head (Funakoshi et al., 2004; Kanaya and Ibaraki, 1998; Kinjo et al., 2008; Oka et al., 2006; Sakamoto et al., 2014).…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional analysis of deformities of the radius and ulna in congenital proximal radioulnar synostosis

Nakasone

Kinjo

et al. 2018

J Hand Surg Eur Vol

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We reconstructed three-dimensional images of radius and ulna in 38 forearms of 25 patients with congenital proximal radioulnar synostosis from their computed tomographic studies. We also analysed correlations between the deformities of radius and ulna and degrees of fixed pronation of these forearms. The average ulnar deviation, flexion and internal rotation deformities of the radius were 6°, 3° and 18°, respectively. The average radial deviation, extension and internal rotation deformities of the ulna were 3°, 4° and 30°, respectively. The flexion deformity of the radius and the internal rotation deformity of the radius and ulna were correlated significantly with degree of fixed pronation. We conclude that the patients with congenital proximal radioulnar synostosis have remarkable flexion deformity of the radius and internal rotation deformity of the radius and ulna, which might impede forearm rotation after corrective surgery in the proximal part of the forearm.

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Modified osteotomy (Kanaya’s procedure) for congenital proximal radioulnar synostosis with posterior dislocation of radial head

Cited by 21 publications

References 13 publications

One-stage rotational osteotomy for congenital radioulnar synostosis

One-stage rotational osteotomy for congenital radioulnar synostosis

Results after treatment of congenital radioulnar synostosis: a systematic review and pooled data analysis

Three-dimensional analysis of deformities of the radius and ulna in congenital proximal radioulnar synostosis

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