Treatment of congenital radioulnar synostosis with radial derotational osteotomy and local subcutaneous pedicled fat flap filling in fusion area_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DONG Yanzhao ¹ , HU Pengfei ² , LIU Fuyun ¹ , NIU Xueqiang ¹ , FENG Guoming ¹ , WANG Feipeng ¹

1. Department of Orthopedics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;
2. Department of Orthopedics, Zhengzhou People’s Hospital, Zhengzhou Henan, 450000, P.R.China;

Corresponding author：

DONG Yanzhao, Email: dongyanzhao515@126.com

Keywords：

Congenital radioulnar synostosis; osteotomy; pedicled fat flap; internal fixation

DOI：

10.7507/1002-1892.201911079

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Objective To investigate the effectiveness of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation for the treatment of congenital radioulnar synostosis.Methods Between February 2014 and June 2018, 36 patients (41 sides) with congenital radioulnar synostosis were analyzed retrospectively, including 21 males and 15 females, aged 2.5-4.5 years with an average of 3.1 years. The fixed pronation deformity of the forearm ranged from 30° to 90° with an average of 71.6°, and the range of motion of the elbow flexion was 120°-135° with an average of 128.2°. According to the Cleary-Omer classification, there were 8 sides of type Ⅱ, 17 sides of type Ⅲ, and 16 sides of type Ⅳ. All patients were treated by local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation. The range of motion of the elbow, muscle strength, joint stability, and patient discomfort were evaluated by using the Broberg and Morrey elbow scoring system preoperatively and postoperatively. In addition, the ability for daily living of the affected limb was evaluated by using the Failla grading standard.Results Radial nerve palsy occurred in 3 cases, and nerve function recovered at 2-4 weeks after operation. All the 36 cases were followed up 6-52 months, with an average of 38 months. All osteotomy sites healed, the healing time was 5-12 weeks (mean, 6.3 weeks), and the pedicled fat flap between the radius and ulna survived when the internal fixation was taken. At last follow-up, the flexion range of motion of elbow joint was not decreased, and the pronation and supination range of motion of forearm were improved. The elbow flexion range of motion was 125°-135° with an average of 132.4°. The pronation range of motion of forearm was 15°-45° with an average of 30.1°, and the supination range of motion of forearm was 10°-40° with an average of 22.6°. At last follow-up, the Broberg and Morrey elbow scores increased from the preoperative 85.6±1.0 to 91.8±1.8, showing significant difference (t=25.593, P=0.000). Moreover, the results were good in 3 sides, fair in 9 sides, and poor in 29 sides according to the Failla grading standard before operation, with an excellent and good rate of 7.3%. At last follow-up, the results were excellent in 6 sides, good in 28 sides, and fair in 7 sides, with an excellent and good rate of 82.9%, showing significant difference when compared with preoperative value (Z=−5.781, P=0.000).Conclusion The application of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation is an effective surgical method for the treatment of congenital radioulnar synostosis. It can restore the partial rotation function of the forearm and improve the quality of life of children.

Citation： DONG Yanzhao, HU Pengfei, LIU Fuyun, NIU Xueqiang, FENG Guoming, WANG Feipeng. Treatment of congenital radioulnar synostosis with radial derotational osteotomy and local subcutaneous pedicled fat flap filling in fusion area. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 820-825. doi: 10.7507/1002-1892.201911079 Copy

1.	Bishay SN. Minimally invasive single-session double-level rotational osteotomy of the forearm bones to correct fixed pronation deformity in congenital proximal radioulnar synostosis. J Child Orthop, 2016, 10(4): 295-300.
2.	Kepenek-Varol B, Hoşbay Z. Is short-term hand therapy effective in a child with congenital radioulnar synostosis? A case report. J Hand Ther, 2019. [Epub ahead of print].
3.	Nakasone M, Nakasone S, Kinjo M, et al. Three-dimensional analysis of deformities of the radius and ulna in congenital proximal radioulnar synostosis. J Hand Surg (Eur Vol), 2018, 43(7): 739-743.
4.	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.
5.	Garg G, Gupta SP. Surgical outcome of delayed presentation of congenital proximal radioulnar synostosis. SICOT J, 2015, 1: 33.
6.	Pei X, Han J. Efficacy and feasibility of proximal radioulnar derotational osteotomy and internal fixation for the treatment of congenital radioulnar synostosis. J Orthop Surg Res, 2019, 14(1): 81.
7.	Horii E, Koh S, Hattori T, et al. Single osteotomy at the radial diaphysis for congenital radioulnar synostosis. J Hand Surg (Am), 2014, 39(8): 1553-1557.
8.	Sakamoto S, Doi K, Hattori Y, et al. Modified osteotomy (Kanaya’s procedure) for congenital proximal radioulnar synostosis with posterior dislocation of radial head. J Hand Surg (Eur Vol), 2014, 39(5): 541-548.
9.	Kanaya K, Iba K, Yamashita T. Long-term results after a free vascularized adipofascial graft for congenital proximal radioulnar synostosis with an average follow-up of 10 years: a series of four cases. J Shoulder Elbow Surg, 2016, 25(8): 1258-1267.
10.	Cleary JE, Omer GE Jr. Congenital proximal radio-ulnar synostosis. Natural history and functional assessment. J Bone Joint Surg (Am), 1985, 67(4): 539-545.
11.	Farzan M, Daneshjou Kh, Mortazavi SMJ, et al. Congenital radioulnar synostosis: A report of 11 cases and review of literature. Acta Medica Iranica, 2002, 40(2): 126-131.
12.	Hung NN. Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis. J Child Orthop, 2008, 2(6): 481-489.
13.	陈文, 王体沛, 邢敦凯, 等. 尺桡骨中段旋转截骨术治疗先天性上尺桡关节融合及并发症探讨. 中华小儿外科杂志, 2006, 27(4): 194-196.
14.	Hwang JH, Kim HW, Lee DH, et al. One-stage rotational osteotomy for congenital radioulnar synostosis. J Hand Surg (Eur Vol), 2015, 40(8): 855-861.
15.	Dal Monte A, Andrisano A, Mignani G, et al. A critical review of the surgical treatment of congenital proximal radio-ulnar synostosis. Ital J Orthop Traumatol, 1987, 13(2): 181-186.
16.	Miura T, Nakamura R, Suzuki M, et al. Congenital radio-ulnar synostosis. J Hand Surg Br, 1984, 9(2): 153-155.
17.	Kanaya F. Mobilization of congenital proximal radio-ulnar synostosis: a technical detail. Tech Hand Up Extrem Surg, 1997, 1(3): 183-188.
18.	Funakoshi T, Kato H, Minami A, et al. The use of pedicled posterior interosseous fat graft for mobilization of congenital radioulnar synostosis: a case report. J Shoulder Elbow Surg, 2004, 13(2): 230-234.
19.	黄娜, 文辉才, 付建华, 等. 改良菱形皮瓣在面部皮肤软组织缺损修复中的应用. 中国修复重建外科杂志, 2019, 33(2): 207-211.

1. Bishay SN. Minimally invasive single-session double-level rotational osteotomy of the forearm bones to correct fixed pronation deformity in congenital proximal radioulnar synostosis. J Child Orthop, 2016, 10(4): 295-300.
2. Kepenek-Varol B, Hoşbay Z. Is short-term hand therapy effective in a child with congenital radioulnar synostosis? A case report. J Hand Ther, 2019. [Epub ahead of print].
3. Nakasone M, Nakasone S, Kinjo M, et al. Three-dimensional analysis of deformities of the radius and ulna in congenital proximal radioulnar synostosis. J Hand Surg (Eur Vol), 2018, 43(7): 739-743.
4. 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.
5. Garg G, Gupta SP. Surgical outcome of delayed presentation of congenital proximal radioulnar synostosis. SICOT J, 2015, 1: 33.
6. Pei X, Han J. Efficacy and feasibility of proximal radioulnar derotational osteotomy and internal fixation for the treatment of congenital radioulnar synostosis. J Orthop Surg Res, 2019, 14(1): 81.
7. Horii E, Koh S, Hattori T, et al. Single osteotomy at the radial diaphysis for congenital radioulnar synostosis. J Hand Surg (Am), 2014, 39(8): 1553-1557.
8. Sakamoto S, Doi K, Hattori Y, et al. Modified osteotomy (Kanaya’s procedure) for congenital proximal radioulnar synostosis with posterior dislocation of radial head. J Hand Surg (Eur Vol), 2014, 39(5): 541-548.
9. Kanaya K, Iba K, Yamashita T. Long-term results after a free vascularized adipofascial graft for congenital proximal radioulnar synostosis with an average follow-up of 10 years: a series of four cases. J Shoulder Elbow Surg, 2016, 25(8): 1258-1267.
10. Cleary JE, Omer GE Jr. Congenital proximal radio-ulnar synostosis. Natural history and functional assessment. J Bone Joint Surg (Am), 1985, 67(4): 539-545.
11. Farzan M, Daneshjou Kh, Mortazavi SMJ, et al. Congenital radioulnar synostosis: A report of 11 cases and review of literature. Acta Medica Iranica, 2002, 40(2): 126-131.
12. Hung NN. Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis. J Child Orthop, 2008, 2(6): 481-489.
13. 陈文, 王体沛, 邢敦凯, 等. 尺桡骨中段旋转截骨术治疗先天性上尺桡关节融合及并发症探讨. 中华小儿外科杂志, 2006, 27(4): 194-196.
14. Hwang JH, Kim HW, Lee DH, et al. One-stage rotational osteotomy for congenital radioulnar synostosis. J Hand Surg (Eur Vol), 2015, 40(8): 855-861.
15. Dal Monte A, Andrisano A, Mignani G, et al. A critical review of the surgical treatment of congenital proximal radio-ulnar synostosis. Ital J Orthop Traumatol, 1987, 13(2): 181-186.
16. Miura T, Nakamura R, Suzuki M, et al. Congenital radio-ulnar synostosis. J Hand Surg Br, 1984, 9(2): 153-155.
17. Kanaya F. Mobilization of congenital proximal radio-ulnar synostosis: a technical detail. Tech Hand Up Extrem Surg, 1997, 1(3): 183-188.
18. Funakoshi T, Kato H, Minami A, et al. The use of pedicled posterior interosseous fat graft for mobilization of congenital radioulnar synostosis: a case report. J Shoulder Elbow Surg, 2004, 13(2): 230-234.
19. 黄娜, 文辉才, 付建华, 等. 改良菱形皮瓣在面部皮肤软组织缺损修复中的应用. 中国修复重建外科杂志, 2019, 33(2): 207-211.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of congenital radioulnar synostosis with radial derotational osteotomy and local subcutaneous pedicled fat flap filling in fusion area

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