Rotational osteotomy of forearm bones for treatment of congenital radioulnar synostosis in children

Abstract

Background: Congenital radioulnar synostosis (CRUS) is a rare upper limb deformity characterized by impaired rotational movement of the forearm. Rotational osteotomy is a commonly employed surgical procedure for treatment. This study aimed to analyze its surgical efficacy in treating CRUS in children.

Methods: 22 children (24 limbs) with CRUS from January 2010 to December 2023 were retrospectively collected. Rotational osteotomy of proximal ulna and distal radius was performed. Forearm function was evaluated using Failla scores and hygiene and self-care scores in Activities of daily Living score (ADL score). In addition, patients were further grouped and compared according to type of ulnar internal fixation and age at surgery.

Results: 22 patients (14 males, 8 females), with an average age of 6.0 years and an average follow-up time of 56 months. The mean pronation angle before surgery was 75.0 ± 11.3°, the mean postoperative pronation angle was 3.8 ± 7.1°, and the mean correction degree was 78.8 ± 12.9°. The average Failla scores were 5.6 ± 2.1 points before operation and 14.0 ± 1.0 points after operation. The average scores of hygiene and self-care scores were 19.0 ± 5.1 points before surgery and 36.0 ± 3.9 points after surgery. No child developed complications such as osteofascial compartment syndrome or infection. The correction angle in the plate fixation group was 86.8 ± 10.6°, while in the K-wires group was 72.0 ± 10.7°. The postoperative Failla scores in the older age group were 13.0 ± 1.1 points, and in the younger age group were 14.3 ± 0.8 points.

Conclusion: Rotational osteotomy of forearm bones is safe and effective in the treatment of CRUS in children. Ulnar plate fixation has better correction than K-wires. Furthermore, younger children have better surgical outcomes than older ones.

Keywords: Children; Congenital radioulnar synostosis; Rotational osteotomy.

Fig. 1

Typical case 1, male, bilateral CRUS, age at surgery 4 years. A-B: preoperative left forearm anteroposterior and lateral x-rays, C: preoperative elbow-flexed neutral appearance, D: preoperative left-handed bowl holding, E–F: 1 day postoperative left forearm anteroposterior and lateral x-rays, G-H: 3.5 years postoperative left forearm anteroposterior and lateral x-rays. I-N: 3.5 years postoperative follow-up appearance photographs. The forearm can perform pronation and supination movements with compensation at the shoulder and wrist joints

Fig. 2

Typical case 2. male, left CRUS, age at surgery 6 years old. A-B: Preoperative anteroposterior and lateral X-rays of the left forearm, C-D: Preoperative gross examination. E–F: Postoperative anteroposterior and lateral X-rays of the left forearm on the first day, G-H: Postoperative anteroposterior and lateral X-rays of the left forearm at 4 months. I-N: Follow-up photographs of the appearance at 4 months postoperatively. The forearm can perform pronation and supination movements with compensation at the shoulder and wrist joints