DYNAMIC TREATMENT OF RADIOULNAR SYNOSTOSIS

Abstract

Classically Radioulnar Synostosis is corrected by rotation-osteotomy. Kanaya first presented a technique for “dynamic” treatment of the deformity. In our institution two cases were treated with a procedure according to Kanayas technique. A four and half year old girl suffered from bilateral radioulnar synostosis, thus presenting the classic indication for surgical correction at least of one side – in our right handed case the left side. A forteen year old boy suffered from radioulnar synostosis of his right upper limb. An increasing luxation of the radial head, causing pain and deformity and decreasing function of the elbow necessitated a surgical intervention. The procedure used was performed identically in both cases: Division of the synostosis and shortening-wedge osteotomy of the proximal radius as described by Kanaya. A deepithelialized fasciocutaneous flap was raised from the dorsum of the proximal forearm and rotated in a position between the separated bones. A cast was applied for six weeks.

Wound healing and consolidation of bones was achieved without problems in both cases. At a 12 months follow up the space between radius and ulna remained open, with no evidence of reoccurence of the deformity. Opening of the synostosis did not affect ellbow flexion and extension and produced an active ROM of about 30 to 40 degrees in pronation; both patients reached neutral position but did neither achieve passive nor active supination.

In our hands Kanayas technique was sufficient for bone separation and produced some active movement, but could not produce active supination. Investigation of the wrists did not reveal deformities of these joints. At the moment the reason for the lack of real supination is not clear. Actually this problem has to be solved to improve the technique to a real dynamic treatment of radioulnar synostosis.