Elsevier

Hand Clinics

Volume 23, Issue 2, May 2007, Pages 227-234
Hand Clinics

Management of Posttraumatic Metadiaphyseal Radioulnar Synostosis

https://doi.org/10.1016/j.hcl.2007.03.005Get rights and content

Posttraumatic radioulnar synostosis results in functional loss of forearm rotation. Treatment preference is to excise the synostosis when associated fractures have healed or when the process is radiographically static. Interposition material is used in the region of the proximal radioulnar joint or when the medullary canal of the radius or ulna is breached. Irradiation is limited to lesions at or proximal to the radial tuberosity. Postoperative management includes resting splint that holds the extremity in the extremes of forearm rotation, and intermittent active and passive range of motion exercises. Anti-inflammatory medications are used only during hospitalization. Results have shown a good functional arc of pronosupination, and no recurrence, especially when the process is limited to the midforearm.

Section snippets

Literature review

Studies on posttraumatic radioulnar synostosis consist of single case reports or small series and can be divided into two groups: the radioulnar synostosis related to forearm fractures and radioulnar synostosis related to biceps tendon repairs. Typical of the first group is Stern and Drury's [1] report of 87 forearm fractures treated by plating with seven radioulnar synostoses. These patients had a high degree of crush injury and five of the seven sustained head injuries. Vince and Miller [2]

Surgical technique

This description is limited to resection of radioulnar synostosis distal to the bicipital tuberosity and proximal to the distal radioulnar joint (DRUJ). In contradistinction to the elbow and wrist, this dissection is usually straightforward.

Preoperative planning requires a thorough examination of the extremity. Special attention is paid to the vascular status, the integrity of the forearm musculature, and the objective documentation of sensibility with either two-point discrimination or

Discussion

The treatment of posttraumatic radioulnar synostosis has been guided by case reports and small case series with advocates proposing both early and delayed excision followed by some type of intervention to prevent recurrence [2], [3], [4], [5]. Beingessner and colleagues [14] and Sotereanos and colleagues [6] provided good results after performing excision, within 4 months of injury. Most others suggested delaying treatment for up to 12 months [23]. A number of authors have recommended

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