Rotational osteotomy with single incision and elastic fixation for congenital radioulnar synostosis in children: a retrospective cohort study

Abstract

Background: Derotational osteotomy remains the most commonly performed procedure in patients with congenital radioulnar synostosis (CRUS). Bone fixation is mostly performed using K-wires or plates. Many scars, loss of correction and neurovascular complications in the form were the most common complications across the studies. This report introduces a novel, minimally-invasive surgical approach, and reviews our experience.Methods: Twenty-seven children with CRUS were treated using the new technique, including bilateral forearms in 12 cases and unilateral forearm in 15 cases. A transverse osteotomy was performed at the ulnar and radial fusion site, the forearm was derotated osteotomy to the target position, intramedullary nailing was performed, and the elbow was flexed 90 degrees with a long-arm cast after surgery. One week after surgery, the forearm swelling disappeared, the long-arm cast was replaced, the elbow flexed at 90 degrees, and the forearm fixed in the maximum supination position for 4 weeks. Pre-and post-operative positions of the forearm were recorded; the pre-and post-operative activities of daily living (ADL) item scores were recorded for each patient.Results: All patients were followed up postoperatively for a mean duration of 20.7 months. The mean initial pronation deformity was 59.7±12.20 (40 to 100) degrees. The mean correction achieved was 51.2±14.50 degrees, resulting in a mean final position of 8.59±8.10 degrees of supination. The fixed angles of forearm pronation after surgery were corrected to 0-20°, with a mean of 8.33º [standard deviation (SD) 7.98°), and the difference was statistically significant compared with that before surgery (P<0.01). The patients' preand post-operative ADL item scores were 3.6 and 4.5, respectively, which was a 0.9-point change and was statistically significant (P<0.01). After surgery, 26 patients obtained good healing, and only one patient had delayed union, which was healed with forearm immobilization for a further month.Conclusions: Rotational osteotomy with single incision and elastic fixation for CRUS in children is a simple operation, and provides advantages including small trauma, fewer postoperative complications, and good efficacy.

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

“…Because of its rarity and the diversity of fixed position, there is no consensus on the treatment strategy (4,5). So far, multiple surgical techniques and physiotherapy have been reported to be beneficial for this condition with improved life quality (6)(7)(8)(9). However, the indication for surgery remains unclear and the postoperative outcomes remains mixed (1,2).…”

Quantitative Analysis of Deformity in Digital Model of Congenital Radioulnar Synostosis

“…Congenital radioulnar synostosis (CRUS) is a rare congenital deformity of the upper extremity, which usually presents as a pronation deformity of the forearm, and can be bilateral or unilateral. 1 , 2 , 3 This disease may cause difficult experiences for affected children in participating in activities like perineum sanitation and using utensils, thus leading them to develop a variety of psychological problems as they grow up. In severe cases, the patient cannot complete movements, such as carrying a bowl and writing, which affect the patient's daily life, work, social activities, and hobbies.…”