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Radioulnar synostosis

Objectives

1. Describe symptoms and physical signs of congenital radioulnar synostosis
2. Discuss natural history and indications for intervention for radioulnar synostosis
3. Describe complications of treatment for radioulnar synostosis

Discussion
Radioulnar synostosis is one of the more common failures of separation of parts of the upper limb. There are two general types, one of which is characterized by fusion of the radius and ulna at their proximal borders, the other is fused distal to the proximal radial epiphysis. At least some cases are genetically transmitted, in particular regions such as Sicily, the incidence may be higher. It is often not noted until late childhood, as function may be normal, especially in unilateral cases. Increased wrist motion may compensate for the absent forearm motion. One individual went through Army basic training with a radioulnar synostosis. Assessment of function of the untreated individual varies somewhat among reports, Cleary reported on 23 untreated adults who got along famously. It has been suggested that individuals whose forearms are fixed in greater amounts of pronation (> 60 degrees) have more problems than those with around 20 degrees. In bilateral cases where function is impaired, recommendations for the optimum position of the non-dominant arm range from neutral to 30-40 degrees of supination. Neurovascular complications after osteotomy through the synostosis are not rare. Strategies to reduce complications include resection of a portion of the synostosis with external fixation, and performing the osteotomy in the distal radius instead of at the synostosis site. Most attempts to divide the synostosis and insert some type of interpositional material have failed. Success has been reported following vascularized fascio-fatty graft.

References

1. Bayne LG, Costas B, L,, Lourie GM. The upper limb. In: Morrissy RT, Weinstein SL, editors. Pediatric Orthopaedics. Philadelphia: Lippincott-Raven; 1996. p. 781-847.
2. Bolano LE. Congenital proximal radioulnar synostosis: treatment with the Ilizarov method. Journal of Hand Surgery -American Volume 1994; 19( 6): 977-8.
3. Cleary JE, Omer GE, Jr. Congenital proximal radio-ulnar synostosis. Natural history and functional assessment. Journal of Bone & Joint Surgery -American Volume 1985; 67( 4): 539-45.
4. Green WT, Mital MA. Congenital radio-ulnar synostosis: surgical treatment. Journal of Bone & Joint Surgery -American Volume 1979; 61( 5): 738-43.
5. Griffet J, Berard J, Michel CR, Caton J. Congenital superior radioulnar synostoses. A study of 43 cases. International Orthopaedics 1986; 10( 4): 265-9.
6. Hankin FM, Smith PA, Kling TF, Jr., Louis DS. Ulnar nerve palsy following rotational osteotomy of congenital radioulnar synostosis. Journal of Pediatric Orthopedics 1987; 7( 1): 103-6.
7. Hansen OH, Andersen NO. Congenital radio-ulnar synostosis. Report of 37 cases. Acta Orthopaedica Scandinavica 1970; 41( 3): 225-30.
8. Kanaya F, Ibaraki K. Mobilization of a congenital proximal radioulnar synostosis with use of a free vascularized fascio-fat graft. Journal of Bone & Joint Surgery -American Volume 1998; 80( 8): 1186-92.
9. Khalil I, Vizkelety T. Osteotomy of the synostosis mass for the treatment of congenital radio-ulnar synostosis. Archives of Orthopaedic & Trauma Surgery 1993; 113( 1): 20-2.
10. Lescault E, Mulligan J, Williams G. Congenital radioulnar synostosis in an active duty soldier: case report and literature review. Military Medicine 2000; 165( 5): 425-8.
11. Miura T, Nakamura R, Suzuki M, Kanie J. Congenital radio-ulnar synostosis. Journal of Hand Surgery -British Volume 1984; 9( 2): 153-5.
12. Ogino T, Hikino K. Congenital radio-ulnar synostosis: compensatory rotation around the wrist and rotation osteotomy [published erratum appears in J Hand Surg [Br] 1987 Oct; 12( 3): 402]. Journal of Hand Surgery -British Volume 1987; 12( 2): 173-8.
13. Rizzo R, Pavone V, Corsello G, Sorge G, Neri G, Opitz JM. Autosomal dominant and sporadic radio-ulnar synostosis. American Journal of Medical Genetics 1997; 68( 2): 127-34.
14. Simmons BP, Southmayd WW, Riseborough EJ. Congenital radioulnar synostosis. Journal of Hand Surgery -American Volume 1983; 8( 6): 829-38.

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See Also

• Fractures of the Pelvis
• Cerebral Palsy
• Congenital Scoliosis
• Fractures of the Hand and Wrist
• Fractures Associated with Head Injury

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