Treatment of congenital radioulnar synostosis in children: clinical case report

BACKGROUND: Congenital radioulnar synostosis (CRUS) is a rare pathology that leads to disadaptation of the child in everyday life and difficulties in acquiring writing and hygiene skills. Parents of children with this pathology pay attention to the pronation of the forearm and wrist, the absence of rotational movements of the forearm. The diagnosis base on radiographs of the forearm, the type of synostosis is determined according to the Cleary-Omer classification. There is no conservative treatment for this pathology, more than 20 surgical treatment options have been described, which is why the issue of indications and the choice of a specific treatment method remains controversial.

CLINICAL CASES DESCRIPTION: The clinical experience of the treatment of congenital radioulnar synostosis in 12 children in the period from January 2018 to March 2024 is presented. A total of 16 surgical procedures were performed: 14 operations of derotation osteotomy at the synostosis level using the Green's K-wire fixation technique and 2 operations using a combined technique: derotation osteotomy at the synostosis level with K-wire fixation and osteotomy of the radius in the middle third with plate fixation. The technique of surgical intervention and the features of installing the clamps are described in detail. Possible complications are considered. The result of the treatment was traced for 1–5 years after the operation. All patients achieved a functional installation of the forearm in the middle position, improved quality of life, and acquired new hygiene and training skills. In the postoperative period, in 5 cases out of 16 surgical interventions with CRUS, transient neuropathy of the deep branch of the radial nerve was noted, which was manifested by paresis of the extensors of the fingers. There was also 1 case of delayed consolidation when using a two-stage osteotomy.

CONCLUSION: Treatment of radioulnar synostosis at a younger age is less traumatic, since the deformation is not multiplanar and does not require additional correction elements except for forearm derotation, which is an effective surgical intervention that allows eliminating the pronation position of the limb, improving functionality without serious complications. With age, the risk of complications at the time of correction increases, but no statistically significant dependence was found, the sample currently requires expansion for the most accurate comparison of methods.