Giedrė Uždavinytė Šemetienė, Mindaugas Minderis
Vilniaus Universiteto ligoninės Santaros klinikos Plastinės rekonstrukcinės chirurgijos centras
Radioulnar synostosis is a rare complication of forearm fractures, that causes a formation of a bony bridge between radius and ulna, limiting the pronosupination. The aetiology of posttraumatic synostosis is unknown. It seems that the incidence are higher in patients who have suffered a high energy trauma. Specifics of surgical treatment seem to be another possible factor. The aim of surgical treatment is to remove the bony bridge and restore complete range of movement, thus preventing recurrence. The location of posttraumatic radioulnar synostosis determines the type of operation. Successful results are reported in 86.6% cases . Literature does not indicate a preferred type of surgical procedure for this pathology. However it has been shown that surgical interposition of inert material reduces the formation rate of recurrent bony bridge [6,7,8,9]. Literature reports that proximal radial resection is a safe and acceptable procedure to restore the pronosupination of the upper limb and application of bone wax at the resection site is a safe alternative to synostosis resection in patients with proximal radioulnar synostosis, that is too extensive to allow a safe and discrete resection, involves the articular surface and is associated with an anatomic deformity . We describe a clinical case when a child with posttraumatic radioulnar synostosis was successfully treated by performing a proximal resection of radius and applying bone wax at the resection site. The rotation of 180 degrees was restored during the operation active rotation on the first postoperative day was gained up to 110-120 degrees. Early and intensive postoperative rehabilitation prevents the recurrence of synostosis. It is evident that there was no soft tissue contracture developed even over a 6 year period. Early postoperative exercises prevent the body bridge formation. There was no recurrence of synostosis after one year.
Keywords: Proximal radioulnar joint, synostosis, pronosupination, proximal radial resection