Efficacy and feasibility of proximal radioulnar derotational osteotomy and internal fixation for the treatment of congenital radioulnar synostosis

BACKGROUND: The aim of this study was to assess the feasibility and efficacy of proximal radioulnar derotational osteotomy followed by internal fixation for the treatment of congenital radioulnar synostosis (CRUS). METHODS: Between May 2008 and August 2016, 31 patients (36 forearms) with CRUS who underwent derotational osteotomy at the proximal radioulnar synostosis site were evaluated. There were 20 boys and 11 girls. The mean age at the time of surgery was 4.87 ± 3.06 (range, 2 to 13) years. The forearm was derotated to the goal position (20 degrees of supination to 10 degrees of pronation) using plates for internal fixation and plaster splints for external immobilization. Pre- and postoperative positions of the forearm were recorded; forearm function was evaluated based on the classification system proposed by Failla et al. RESULTS: The mean follow-up duration was 55.19 ± 27.10 (24 to 123) months. The mean initial pronation deformity was 62.92 ± 7.11 (55 to 80) degrees. The mean correction achieved was 70.86 ± 9.58 (50 to 90) degrees, resulting in a mean final position of 7.94 ± 7.25 degrees of supination (20 degrees of supination to 10 degrees of pronation). Based on the Failla classification system, 2 forearms were rated as good, 30 were rated as fair, and 4 were rated as poor preoperatively. At the final follow-up, 34 forearms were rated as excellent and 2 were rated as good. All patients achieved bone union after 2 months. Complications occurred in three patients (two transient nerve palsies and one compartment syndrome), and the overall complication rate was 9.7%. CONCLUSIONS: Proximal radioulnar derotational osteotomy followed by plate fixation is a safe and feasible procedure with a low complication rate. The technique can effectively improve the function of the forearm. LEVEL OF EVIDENCE IV: Retrospective case series