An analysis of results of derotation osteotomy through the synostosis mass in cases of Congenital Radioulnar Synostosis

Siva Swaminathan, S (2012) An analysis of results of derotation osteotomy through the synostosis mass in cases of Congenital Radioulnar Synostosis. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Congenital Radioulnar Synostosis is a rare congenital anomaly when the failure of segmentation of radius and ulna results in a fixed position of the forearm ranging from neutral rotation to severe pronation.When the deformity is mild, little disability is evident, as the ipsilateral shoulder and wrist can compensate effectively but with significant pronation the activities of daily living including dressing, eating, grasping objects in the palm of the hand can be severely impaired. Attempts at resection of the synostosis in order to restore rotation of forearm have, on the whole been unsatisfactory due to loss of correction and vascular compromise following extensive soft tissue release. More recently osteotomy through the synostosis mass and fixing the forearm in a functional position has been advocated. In this study we describe the surgical technique of osteotomy through the synostosis mass, results and advantages of this procedure over other surgeries. AIMS AND OBJECTIVES: 1. To evaluate the results and functional outcome of correcting the deformity by an osteotomy through the synostosis mass in cases of congenital proximal radioulnar synostosis. 2. To study the advantage of this procedure over other techniques of osteotomy. MATERIALS AND METHODS: In our instituition, 12 patients with congenital radioulnar synostosis were selected for this prospective study, after obtaining Ethical Committe approval. All patients were treated with osteotomy through the synostosis mass and were followed up for a period of one year. The age group of the patients varied between 4-11 years, with the average being 6 years. The period of this prospective study was from July 2009 - July 2011. Of the 12 patients selected, 7 were male and 5 were female. 9 cases had bilateral radioulnar synostosis and 3 had unilateral radiulnar synostosis. There was no family history of radioulnar synostosis in any of the patient and there was no syndromic association also in any of the cases. Inclusion Criteria - Greater than 20 degrees of pronation on the right side with significant difficulties in daily activities, particularly eating. Preoperative Planning - X- ray of the involved upper extremity, both anteroposterior and lateral views were taken in all patients. RESULTS: All of the cases were rated as improved and all but one had a smooth postoperative course. One patient had transient posterior interosseous nerve palsy, which recovered in three weeks time with conservative line of management. The results were graded as excellent in four patients (forearms in supination greater than 30 degrees)in whom anatomical and functional results were such that they had no handicap in normal activities and the position of the forearm was considered ideal. The results in eight patients were graded as good, functionally, as the patients would have preferred 10-20 degrees more supination on the forearm operated on. Bony union was achieved at the end of 8 weeks in all the 12 cases. CONCLUSION: Congenital radioulnar synostosis is a rare deformity, frequently bilateral, and more commonly seen in male patients. The etiology is multifactorial , with both sporadic mutations and undefined genetic patterns. Surgical indications are based on the degree of deformity and bilaterality. If bones of the forearm are in ideal position of rotation, the use of both hands can be amazingly efficient without the motions of supination and pronation. From our study, we conclude that if the position of the forearm needs to be changed, a well controlled rotational osteotomy through the conjoined radio-ulnar mass is the best way of accomplishing this.

Item Type: Thesis (Masters)
Uncontrolled Keywords: derotation osteotomy ; synostosis mass ; congenital radioulnar synostosis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 16:21
Last Modified: 17 Sep 2017 07:11

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