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Radioulnar Synostosis

Topic updated on 05/14/16 8:29pm
Introduction
  • Proximal radioulnar synostosisBony bridge which develops between radius and ulna secondary to a specific event
    • must differentiate from congenital radioulnar synostosis 
  • Epidemiology
    • incidence
      • 3% to 9%
    • risk factors
      • trauma related
        • Monteggia fracture
        • both bone forearm fractures at the same level
        • open fracture,
        • significant soft-tissue lesion
        • comminuted fracture
        • high energy fracture
        • associated head trauma
        • bone fragments on the interosseous membrane
      • treatment related
        • use of one incision for both radius and ulna
        • delayed surgery > 2 weeks
        • screws that penetrate interosseous membrane
        • bone grafting into interosseous membrane
        • prolonged immobilization
Anatomy
  • Forearm anatomy  
Presentation
  • History
    • previous trauma or surgery in forearm
  • Symptoms
    • pain with incomplete synostosis
    • no pain with complete synostosis
  • Physical exam
    • pronation and supination blocked both actively and passively
Imaging
  • Radiographs
    • recommended views
      • AP and lateral of forearm, elbow, and wrist
    • findings
      • bony bridge between radius and ulna 
Treatment
  • Operative
    • surgical resection of synostosis, irradiation, and indomethacin
      • indications
        • mature post-traumatic synostosis that impairs function
        • excision indicated at 4-6 months
          • timing is controversial
            • excision too early can lead to recurrence
            • excision too late can lead to surrounding joint contractures
      • results
        • results of resection are poor except for midshaft synostosis
    • proximal radial excision
      • indications
        • reserved for patients who have a proximal radioulnar synostosis that is too extensive to allow a safe resection, involves the articular surface, and is associated with an anatomic deformity.
      • results
        • can provide forearm rotation
        • associated with radioulnar and/or elbow instability

 

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