Congenital radioulnar synostosis: symptom complex and surgical treatment

Cover Page

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Congenital radioulnar synostosis (CRUS) is a rare musculoskeletal disease with a wide-ranging symptom complex. Attitudes toward surgical treatment of the disease is very diverse, ranging from complete negation to acceptance. When choosing a treatment method, high recurrence and complication rates should be taken into account.

Aims. To analyze the clinical implications of CRUS and to identify optimal treatment options.

Materials and methods. From 2008 to 2015, 54 patients (31 boys and 23 girls; aged 1–14 years) with CRUS were examined and treated. Presenting complaints and the possible factors leading to disease development were investigated; orthopedic examination, roentgenography, electromyography, and computed tomography were performed. The treatment approach was determined on the basis of the clinicoroentgenological presentation.

Results. All cases of CRUS were sporadic. In 43.7% patients, risk factors resulting in disease development were detected. Unilateral lesions were observed in 30 patients, whereas bilateral lesions were observed in 24 patients. According to the Cleary and Omer classification, the first type is the rarest; it is distinguished by the absence of bony fusion and close to average forearm positioning. In such cases, operative treatment is not necessary. For the second and third types, pronounced pronation forearm realignment requiring corrective derotational osteotomy of the radial bone is the main factor. For the fourth type, the main functional disorder is the restriction of the forearm flexion; treatment for this type involves resection of the radius head. We attempted to divide the synostosis 
(to achieve active movements) in five patients; however, we were unsuccessful. In three patients, synostosis recurrence occurred; and in two patients, active movements were not obtained after surgery. In four patients, radial nerve neuropathy was detected in the postoperative period after conservative therapy. In two patients, ulnar fractures occurred as a result of a fall; in one of these patients, fragment apposition was required.

Conclusions. Clinicoroentgenological manifestations of CRUS determine the treatment options. The most typical and important of these manifestations is the pronation positioning of the forearm. In such cases, it is reasonable to start operative CRUS treatment after 3 years. All variants of deformation are indicators for operation, and treatment options are determined by the degree of severity of the deformation. Attempts to form the forearm bone neoarthrosis in order to get rotational movements is not effective and can result in deformation recurrence.

Full Text

Restricted Access

About the authors

Evgeny V Prokopovich

The Turner Scientific and Research Institute for Children’s Orthopedics

Author for correspondence.
Email: afonichev@list.ru
MD, PhD, orthopedic surgeon of the department of trauma sequelae and rheumatoid arthritis. Th e Turner Scientifi c and Research Institute for Children’s Orthopedics.

Mikhail A Konev

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, chief of the department of trauma sequelae and rheumatoid arthritis. The Turner Scientifi c and Research Institute for Children’s Orthopedics

Konstantin A Afonichev

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, PhD, professor, head of the department of trauma eff ects and rheumatoid arthritis. The Turner Scientifi c and Research Institute for Children’s Orthopedics, Saint-Petersburg, Russian Federation.

Ivan E Prokopovich

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, resident of the Turner Scientifi c and Research Institute for Children’s Orthopedics

Aleksander B Kovzikov

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, orthopedic and trauma surgeon of the department of trauma eff ects and rheumatoid arthritis. Th e Turner Scientifi c and Research institute for Children’s Orthopedics.

Maksim S Nikitin

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, orthopedic and trauma surgeon of the department of trauma effects and rheumatoid arthritis. The Turner Scientifi c and Research Institute for Children’s Orthopedics.

Vladimir V Selizov

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, orthopedic and trauma surgeon of the department of trauma eff ects and rheumatoid arthritis . The Turner Scientifi c and Research institute for Children’s Orthopedics.

Tatyana S Vinokurova

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: afonichev@list.ru
MD, PhD, leading research associate of the laboratory of physiological and biomechanical research. The Turner Scientifi c and Research Institute for Children’s Orthopedics

References

  1. Никифорова Е.К. Врожденные и паралитические заболевания верхней конечности // Многотомное руководство по хирургии. - М., 1962. - Том 11. - С. 74. [Nikiforova EK. Vrozhdennye i paraliticheskie zabolevaniya verkhnei konechnosti. In: Mnogotomnoe rukovodstvo po khirurgii. Moscow; 1962. Vol. 11. P.74. (In Russ).]
  2. Андрианов В.Л., Дедова В.Д., Колядицкий В.Г., Кузьменко В.В. Врожденные деформации верхних конечностей. - М.: Медицина, 1972. - С. 48-67. [Andrianov VL, Dedova VD, Kolyaditskii VG, Kuz’menko VV Vrozhdennye deformatsii verkhnikh konechnostei. Moscow: Meditsina; 1972. P. 48-67. (In Russ).]
  3. Меженина Е.П. Врожденные уродства. - Киев: Здоровья, 1974. - С. 43-45. [Mezhenina EP. Vrozhdennye urodstva. Kiev: Zdorov’ya; 1974. P. 43-45. (In Russ).]
  4. Колядицкий В.Г. Врожденные синостозы костей предплечья: Дис. ... канд. мед. наук. - М., 1967. [Kolyaditskiy VG. Vrozhdennye sinostozy kostey predplech’ya. [dissertation] Moscow; 1967. (In Russ).]
  5. Абальмасова Е.А., Лузина Е.В. Врожденные деформации опорно-двигательного аппарата и причины их происхождения. - Ташкент: Медицина, 1976. - С. 131-135. [Abal’masova EA, Luzina EV. Vrozhdennye deformatsii oporno-dvigatel’nogo apparata i prichiny ikh proiskhozhdeniya. Tashkent: Meditsina; 1976. P. 131-135. (In Russ).]
  6. Canale ST. Congenital radioulnar synostosis. In: Campbell’s Operative Orthopaedics. Vol. II. Canale ST, Beaty JH. 12th ed., International Edition. Philadelphia: Elsevier Mosby; 2013. P. 1129-1131.
  7. Simmons BP, Southmayd WW, Riseborough EJ. Congenital radioulnar synostosis. J Hand Surg Am. 1983;8(6):829-838. doi: 10.1016/s0363-5023(83)80078-1.
  8. Чаклин В.Д. Хирургия верхней конечности. Том 11. Книга 1. - М.: Медгиз, 1960. - С. 81. [Chaklin VD. Khirurgiya verkhnei konechnosti. Vol. 11. Kniga 1. Moscow: Medgiz; 1960. P. 81. (In Russ).]
  9. Green WT, Mital MA. Congenital radioulnar sinostosis: surgical treatment. J Bone Jt Surg. 1979;61(5):738-743.
  10. Rubin G, Rozen N, Bor N. Gradual correction of congenital radioulnar synostosis by an osteotomy and Ilizarov external fixation. J Hand Surg Am. 2013;38(3):447-52. doi: 10.1016/j.jhsa.2012.10.037.
  11. Van Heest AE1, Lin TE, Bohn D. Treatment of blocked elbow flexion in congenital radioulnar synostosis with radial head excision: a case series. J Pediatr Orthop. 2013;33(5):540-3. doi: 10.1097/BPO.0b013e318292c187.
  12. Ogino T, Hikino K. Congenital radio-ulnar synostosis: compensatory rotation around the wrist and rotation osteotomy. J Hand Surg Br. 1987;12(2):173-178. doi: 10.1016/0266-7681(87)90006-4.
  13. Шведовченко И.В. Радиоульнарный синостоз // Ортопедия: Национальное рук-во / Под ред. С.П. Миронова, Г.П. Котельникова. - М., 2013. - С. 182-183. [Shvedovchenko IV. Radio-ulnar synostosis. In: Mironov SP, Kotel’nikov GP, editors. Ortopedic:
  14. National guidelines. Moscow; 2013. P. 182-183. (In Russ).]
  15. Чаклин В.Д. Основы оперативной ортопедии и травматологии. - М.: Медицина, 1964. - С. 165-167. [Chaklin VD. Osnovy operativnoi ortopedii i travmatologii. Moscow: Meditsina; 1964. P. 165-167. (In Russ).]
  16. Прокопова Л.В. Врожденные пороки развития конечностей // Костнопластические операции у детей / Под ред. М.Л. Дмитриева, Г.А. Баирова, К.С. Терновой, Л.В. Прокоповой. - Киев: Здоровья, 1974. - С. 293-342. [Prokopova LV. Vrozhdennye poroki razvitiya konechnostei. In: Dmitriev ML, Bairov GA, Ternova KS, Prokopova LV, editors. Kostnoplasticheskie operatsii u detei. Kiev: Zdorov’ya; 1974. P. 293-342. (In Russ.)]
  17. Tagima T, Ogisho N, Kanaya F. Folow-up study of joint mobilization of proximal radio-ulnar sinostosis. Paper presented at: American Society of Surgery of the Hand meeting. Cincinnati, OH, 1994.
  18. Мовшович И.А. Оперативная ортопедия: Руководство для врачей. - М.: Медицина, 1994. - С. 139. [Movshovich IA. Operativnaya ortopediya: Rukovodstvo dlya vrachei. Moscow: Meditsina; 1994. P. 139. (In Russ).]
  19. Hwang JH, Kim HW, Lee DH, et al. One-stage rotational osteotomy for congenital radioulnar synostosis. J Hand Surg Eur. 2015; Mar 31.
  20. Shingade VU, Shingade RV, Ughade SN. Results of single-staged rotational osteotomy in a child with congenital proximal radioulnar synostosis: subjective and objective evaluation. J Pediatr Orthop. 2014;34(1):63-69. doi: 10.1097/BPO.0b013e3182a00890.
  21. Boireau P, Laville JM. Rotational osteotomy technique for congenital radio-ulnar sinostosis with central medullary nailing and external fixation. Rev Chir Orthop Reparatrice Appar. Mot. 2002;88:812.
  22. Чукичев А.В., Кононенко М.П., Огошков А.В., Гудков В.А. Хирургическое лечение врожденного радиоульнарного синостоза / Актуальные вопросы лечения заболеваний и повреждений опорно-двигательного аппарата у детей: Материалы Всероссийской научно-практической конференции детских травматологов-ортопедов в г. Владимире 23-25 июня 1994 г. СПб., 1994. - С. 38-39. [Chukichev AV, Kononenko MP, Ogoshkov AV, Gudkov VA.
  23. Khirurgicheskoe lechenie vrozhdennogo radioul’narnogo sinostoza. In: Aktual’nye voprosy lecheniya zabolevanii i povrezhdenii oporno-dvigatel’nogo apparata u detei. (Conference proceedings) Materialy Vserossiiskoi nauchno-prakticheskoi konferentsii detskikh travmatologov-ortopedov; Vladimir 23-25 June 1994. -
  24. Saint Petersburg; 1994. P. 38-39. (In Russ).]
  25. Авторское свидетельство № 1388010/15.04.88. Бюл. № 14. Андрианов В.Л., Умханов Х.А., Годунова Г.С., Шведовченко И.В. Способ лечения врожденного синостоза проксимального отдела радиоульнарного сочленения. [Patent RUS No 1388010/15.04.88. Byul. No 14. Andrianov VL, Umkhanov KhA, Godunova GS, Shvedovchenko IV. Sposob lecheniya vrozhdennogo sinostoza proksimal’nogo otdela radioul’narnogo sochleneniya. (In Russ).]
  26. Патент РФ на изобретение № 2373877/27.11.09. Бюл. № 33. Поздеев А.П., Сосненко О.Н. Способ лечения врожденного радиоульнарного синостоза у детей. [Patent RUS No 2373877/27.11.09. Byul. No 33. Pozdeev AP, Sosnenko ON. Sposob lecheniya vrozhdennogo radioul’narnogo sinostoza u detei. (In Russ).]
  27. Cheng PG, Wu SK, Hsu SM, Wang M. Case report: lateral capsular release for acute extension deficit in a child with congenital radioulnar synostosis. J Pediatr Orthop B. 2015;24(1):71-74. doi: 10.1097/BPB.0000000000000113.
  28. Morrissy RT, Weinstein SL, editors. Lovell and Winter᾽s Pediatric Orthopaedics. Vol. 2. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
  29. Waters PM, Simons BP. Congenital abnormalities: elbow region. In: Peimer CA, editor. Surgery of the hand and upper extremity. New York: McGrow-Hill; 1996. P. 2046.
  30. Cleary IE, Omer GE. Congenital radio-ulnar synostosis. Natural history and functional assessment. J Bone Joint Surg. 1985;67(4):539-545.
  31. Соломин Л.Н., Щепкина Е.А., Кулеш П.Н., и др. Определение референтных линий и углов длинных трубчатых костей: пособие для врачей. - СПб.: РНИИТО им. Р.Р. Вредена, 2010. [Solomin LN, Shchepkina EA, Kulesh PN, et al. Opredelenie referentnykh liniy i uglov dlinnykh trubchatykh kostey: posobie dlya vrachey. Saint Petersburg: RNIITO im. Vreden RR; 2010. (In Russ).]
  32. Kapanji A. Upper limb. In: Kapanji A, editor. The physiology of the joints. Vol. 1. Edinburgh: Churchill Livingstone; 1982.

Statistics

Views

Abstract: 4295

PDF (Russian): 4047

PDF (English): 451

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c) 2016 Prokopovich E.V., Konev M.A., Afonichev K.A., Prokopovich I.E., Kovzikov A.B., Nikitin M.S., Selizov V.V., Vinokurova T.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies