Abstract
Background: Heterotopic ossification about the elbow joint can lead to considerable functional disability, including the loss of forearm rotation. Many procedures have been described for the treatment of proximal radio-ulnar synostoses. Varying degrees of success have been achieved, regarding the improvement of the flexion arc, with fewer successful reports concerning the restoration of forearm rotation. The success correlates to the extent of the process, soft-tissue scarring, and anatomical distortion. A new and simple technique to address the non-resectable processes is reported.
Methods: Seven patients were treated by a proximal radial resection procedure, distal to the synostosis, and followed for an average of 80 months (range 24 to 144 months).
Results: The forearm rotation improved from an average fixed pronation of 5_ to an arc of 101_ (range 40_ to 175_). Functional scores improved from an average pre-operative score of 58 (range 50 to 75) to 81 (range 60 to 100) at final review. Complications encountered included one case in which the resection site partially re-ankylosed, resulting in a poor arc of rotation, and one case of a sensory ulnar nerve neurapraxia.
Conclusions: Proximal radial shaft transection provides a safe and reliable method of improving forearm rotation by an average of 100_ and functional scores by an average of 40%. A single technical factor that seems to positively influence this result is the application bone wax at the transection site, although other factors are discussed. The features of proximal radio-ulnar synostoses that are considered to be indications for this simple new procedure are 1) lesions too extensive to allow a safe and discrete resection, 2) involvement of the articular surface, and 3) the presence of anatomical deformation.
The abstracts were prepared by David Stanley. Correspondence should be addressed to him c/o British Orthopaedic Association, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
