Treatment of Congenital Radioulnar Synostosis Using a Free Vascularized Fascia Lata Graft

Abstract

Objective To describe the modified mobilization surgery technique that uses a free vascularized fascia lata graft as the interposition graft, and to evaluate the outcome of this procedure in treating congenital radioulnar synostosis (CRUS). Methods Eleven patients (eight boys and three girls with an average age of 6.0 years) were treated using this procedure between 2012 and 2017 in our institution. Five bilateral cases (four left forearms and one right forearm were treated), and six unilateral cases (three left forearms and three right forearms) were included. All 11 cases were treated with mobilization procedure with free vascularized fascia lata as the interposition graft, and were followed‐up for an average of 2.2 years (range, 2–4 years). The parental satisfaction, postoperative ankylosis at proximal radioulnar joint, and active range of forearm rotation motion (measured by physical examination) were evaluated at the last follow‐up. Results The average preoperative fixed pronation angle was 67.3° (range, 20°–90°). Ipsilateral thumb hypoplasia was noted in one case, and cleft palate and bilateral thumb hypoplasia were noted in one case; none of the patients had a family history of congenital radioulnar synostosis. Pronation and supination splints were used 3 days after the operation and were worn every night for 4–6 months postoperatively. Active and passive rehabilitation for elbow flexion and forearm rotation was initiated 4 weeks postoperatively. All patients were followed up for at least 2 years (average, 26 months; range, 24–48 months). The average forearm pronation range was 39° (range, 20°–60°), and the average forearm supination range was 33.2° (range, 10°–60°) at the latest follow‐up. Re‐ankylosis occurred in one case. An osseous bridge developed between the radius and ulna at the osteotomy site in one case. Radial nerve paralysis developed in two cases and spontaneously resolved 2 months later. Plate breakage was noted in one case 9 weeks postoperatively; however, union was achieved 7 months later. Conclusion Mobilization of proximal radioulnar synostosis using a free vascularized fascia lata graft as the interposition graft may prevent re‐ankylosis and restore the forearm rotation function, making it a good option for the surgical treatment of CRUS.

Unilateral congenital proximal radioulnar synostosis in a 4-year-old boy: A case report

“…Literature has reported that CRUS may be associated with psychosocial problems as the child grows which may affect the patient's self-esteem resulting in depression, violent behavior, anxiety, and problems with relationships [9] . In this patient, there was low self-esteem hence, the need for psychotherapy.…”

Congenital Proximal Radioulnar Synostosis in an Elite Athlete–Case Report

“…Hamiti et al published 12 forearms in 10 patients (aged 3–9 years) achieving improvement of pronation from 35°–70° to 20°–25° with no complications [ 37 ]. To avoid the postoperative re-ankylosis after surgery the subcutaneous fat or free vascularized fascia lata graft may be used [ 38 ]. Considering the above results and complications of surgical treatment, it is evident that the athlete has so far been reluctant to undergo an operation for fear of negative consequences to his developing athletic career.…”

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

“…To the best of our knowledge, this study was the largest cohort on CRUS highlighting the association between radiographic manifestation and clinical forearm functional restriction. In this Several previous studies focusing on the surgical intervention for CRUS highlighted the fixated pronation deformity as one important criterion for surgery (13)(14)(15)(16)), but the latest metaanalysis in 2022 still reached no consensus on the severity of pronation and the necessity of surgery (13). Because of its rarity, most case series did not stress on the correlation of x-ray manifestation and forearm pronation deformity.…”

“…Pronation severity as an important parameter has been mentioned in all publications on operative choices. However, there was no clear correlation between the pronation ankylosis and the necessity of surgery (1-7), even 20 degrees pronation was reported for surgery (14). The optimal age of surgery remains to be investigated, 1.5-9 years old have been reported in the literature (1,2,14).…”