DEROTATION OSTEOTOMY FOR CONGENITAL RADIOULNAR SYNOSTOSIS

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Abstract

Objective: To evaluate the clinical and functional results of derotation osteotomy through the mass of synostosis for
the treatment of congenital radioulnar synostosis in children.
Place and duration of study: Study was conducted in the Department of Orthopaedic and Spine Surgery, Hayatabad
Medical Complex Peshawar from September 2008 to June 2014.
Patients and methods: This series included twelve patients with congenital radioulnar synostosis. All patients were
managed with derotation osteotomy through the synostosis mass. The indication for surgery was limitation in performing
the activities of daily life secondary to pronation deformity. Almost all patients had severe pronation of the forearm.
Preoperative assessment was performed for all patients, including both clinical and radiological assessment. Eight
patients were type III and four patients were type II according to Cleary and Omer. The posterior approach was used to
expose the synostosis and osteotomy was done. Distal fragment rotated to 10 – 20 degree of supination and bone was
fixed with K wires. Another K- wire put in distal fragment at right angle to the bone. This helps in manipulation correction
of rotation.This wire is incorporated in postoperative cast to give stability. The patients were followed up regularly to
check the union at osteotomy site. Wires were removed, when solid union was visible on radiograph.
Results: There were 12 patients operated during the study period. There were five female and seven male patients.
The mean age at surgery was 5.19 years (range 4–11 years). Four patients were unilateral and eight were bilateral. The
right forearm was operated in eleven patients and the left in one patient. The mean time of union of osteotomy was 7
weeks (range 5–12 weeks). The mean correction achieved in the all patients was 77.91° (range 45–100°). All patients
were satisfied and showed improvements in the ability to perform the activity of daily life as compared to pre operative
status. Two patients had complications.
Conclusion: Derotation osteotomy through the synostosis fusion mass to bring the forearm to 10°-20 supination gives
rise to improvement in upper limb function. It is simple and effective method, as the compensatory movement of the
shoulder and wrist will allow proper positioning of the forearm.
Keywords: congenital radioulnar synostosis, derotaation osteotomy, fusion mass

Authors: 
Israr Ahmad
Sanaullah Jan
Malik Javed Iqbal
Mohammad Arif Khan
Awal Hakim
Khawar Kamran

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