Abstract
The proximal radio-ulnar joint (PRUJ) is expendable, as radial head excision for fracture is known to leave an acceptable deficit. This paper discusses a technique for turning the PRUJ en bloc and using it to replace the elbow joint after destruction of the ulnohumeral joint or resection of the distal humerus. PRUJ-plasty can also be used to restore function after arthrodesis of the elbow.
The prerequisite for the procedure is an intact PRUJ. After olecranon osteotomy (or after osteotomy at the same level if there is ankylosis between humerus and ulna), another more distal osteotomy of both the radius and ulna is done, just proximal to the biceps insertion into the radius, using a posterior approach. This creates a segment of proximal radius and ulna, including the PRUJ. This segment is then rotated 90° and fixed to the distal end of the humeral shaft and proximal end of the ulnar shaft. Interposed between humerus and ulna, the PRUJ functions as a vascularised, innervated synovial elbow joint. The range of motion of this new ‘elbow’ is potentially the same as pronation-supination, i.e., 160°.
Three young adults have had the procedure. One young woman had undergone resection of the distal humerus for chondrosarcoma. Later a vascularised fibular graft was used to replace the shaft, but she had no elbow joint and had to use a sling because of instability. The second patient had nonunion of the distal humerus and an ankylosed elbow, with motion only through the nonunion. The third patient had a 10-year old arthrodesis of the elbow following a childhood infection. The PRUJ was intact in all three. Postoperative elbow movement ranged from 70° to 120°. There was some mild lateral instability. The lost function was that of a radial head resection, so adequate pronation and supination were retained.
Because it uses a vascularised, innervated synovial joint, PRUJ-plasty is potentially good for life, making it superior to any synthetic prosthesis.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
