Treatment of Blocked Elbow Flexion in Congenital Radioulnar Synostosis With Radial Head Excision

Heest, Ann E. Van; Lin, Toni E.; Bohn, Deborah C.

doi:10.1097/bpo.0b013e318292c187

Cited by 16 publications

(8 citation statements)

References 12 publications

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“…Most cases (10/16) show overgrowth of the radial head, which is treated with excision 5,9,10, and the radial head was usually entrapped by hypertrophic ligamentous tissues in the flexion position. However, radial head resection may affect the weight-bearing ability of the upper extremity and compromise elbow function on the basis of anatomical and biomechanical considerations.…”

Section: Discussionmentioning

confidence: 99%

Case report

Cheng¹,

Wu²,

Hsu³

et al. 2015

Journal of Pediatric Orthopaedics B

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Section: Discussionmentioning

confidence: 99%

Case report

Cheng¹,

Wu²,

Hsu³

et al. 2015

Journal of Pediatric Orthopaedics B

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“…В мировой литературе наиболее популярна классификация Cleary и Omer [6,7,10,11], кото-рые выделяют следующие типы.…”

Section: Introductionunclassified

“…При наличии жалоб на боли, щелчки, ограни-чение движений в локтевом суставе при переднем вывихе головки лучевой кости (4-й тип синостоза по классификации Cleary и Omer) выполняется рассечение латеральной капсулы локтевого суста-ва [24] и резекция головки лучевой кости [11].…”

Section: Introductionunclassified

Congenital radioulnar synostosis: symptom complex and surgical treatment

Prokopovich

Konev

Afonichev

et al. 2016

Pediatr Traum Orthop Reconstr Surg

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Background. Congenital radioulnar synostosis (CRUS) is a rare musculoskeletal disease with a wide-ranging symptom complex. Attitudes toward surgical treatment of the disease is very diverse, ranging from complete negation to acceptance. When choosing a treatment method, high recurrence and complication rates should be taken into account.Aims. To analyze the clinical implications of CRUS and to identify optimal treatment options.Materials and methods. From 2008 to 2015, 54 patients (31 boys and 23 girls; aged 1–14 years) with CRUS were examined and treated. Presenting complaints and the possible factors leading to disease development were investigated; orthopedic examination, roentgenography, electromyography, and computed tomography were performed. The treatment approach was determined on the basis of the clinicoroentgenological presentation.Results. All cases of CRUS were sporadic. In 43.7% patients, risk factors resulting in disease development were detected. Unilateral lesions were observed in 30 patients, whereas bilateral lesions were observed in 24 patients. According to the Cleary and Omer classification, the first type is the rarest; it is distinguished by the absence of bony fusion and close to average forearm positioning. In such cases, operative treatment is not necessary. For the second and third types, pronounced pronation forearm realignment requiring corrective derotational osteotomy of the radial bone is the main factor. For the fourth type, the main functional disorder is the restriction of the forearm flexion; treatment for this type involves resection of the radius head. We attempted to divide the synostosis (to achieve active movements) in five patients; however, we were unsuccessful. In three patients, synostosis recurrence occurred; and in two patients, active movements were not obtained after surgery. In four patients, radial nerve neuropathy was detected in the postoperative period after conservative therapy. In two patients, ulnar fractures occurred as a result of a fall; in one of these patients, fragment apposition was required.Conclusions. Clinicoroentgenological manifestations of CRUS determine the treatment options. The most typical and important of these manifestations is the pronation positioning of the forearm. In such cases, it is reasonable to start operative CRUS treatment after 3 years. All variants of deformation are indicators for operation, and treatment options are determined by the degree of severity of the deformation. Attempts to form the forearm bone neoarthrosis in order to get rotational movements is not effective and can result in deformation recurrence.

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“…Twenty unique articles reporting additional 266 cases (including bilateral CRUS) since 1996 bring the total number of reported cases to 616. [3][4][5][6][7][8][9][10][11][12][13][14][15] Embryology and Genetics CRUS is most commonly diagnosed in children around the age of 2 to 5 years, 4 although the fusion mass is present before birth. In normal embryonic development, the upper limb bud is formed and begins differentiating around the third to fifth week of gestation.…”

mentioning

confidence: 99%

“…Twenty unique articles reporting additional 266 cases (including bilateral CRUS) since 1996 bring the total number of reported cases to 616. 3-15…”

mentioning

confidence: 99%

Congenital Radioulnar Synostosis

Rutkowski

Samora

2021

J Am Acad Orthop Surg

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Congenital radioulnar synostosis is a rare condition resulting in fusion of the proximal portions of the radius and ulna. Patients commonly present in early childhood with functional deficits because of limited forearm rotation and fixed positioning of the forearm. Compensatory motion and hypermobility are frequently observed at the wrist and shoulder, which may predispose these joints to overuse injury. Plain radiographs are used for diagnosis and classification. The most commonly used classification does not aid in treatment decisions. Limited high-level evidence exists to guide management because the literature primarily consists of case reports and case series. Nonsurgical management is often used, yet surgical management is most commonly reported in the literature. Resection of the synostosis has been shown to have high-complication rates and lead to subpar outcomes. Currently, surgical management most commonly involves one or more derotational osteotomies.

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Treatment of Blocked Elbow Flexion in Congenital Radioulnar Synostosis With Radial Head Excision

Abstract: Case series consistent with level IV evidence; therapeutic study.

Cited by 16 publications

References 12 publications

Case report

Case report

Congenital radioulnar synostosis: symptom complex and surgical treatment

Congenital Radioulnar Synostosis

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