Advertisement

Preoperative radius head dislocation affects forearm rotation after mobilization of congenital radioulnar synostosis

Published:November 10, 2022DOI:https://doi.org/10.1016/j.jos.2022.10.008

      Abstract

      Background

      The present study was carried out to answer three questions: 1) How much forearm rotation can be expected after mobilization of congenital radioulnar synostosis (CRUS)? 2) Does preoperative radius head dislocation affect forearm rotation after mobilization? 3) What factors other than radius head dislocation affect postoperative forearm rotation?

      Methods

      We performed mobilization of CRUS with a free vascularized fascio-fat graft and a radius osteotomy (Kanaya’s procedure) on 26 forearms of 25 patients. The age at the surgery ranged from 5.3 to 13.4 years. The follow-up duration ranged 24–111 months. We classified CRUS into 3 groups according to the dislocation of the radius head: posterior dislocation (N = 13), anterior dislocation (N = 9) and no dislocation (N = 4). Since major complaints of patients and parents were poor forearm rotation and lack of supination, they were evaluated separately.

      Results

      Mean preoperative forearm ankylosis angle was 34.8° (range; neutral to 90° pronation). Preoperative pronation ankylosis angle was higher in the posterior dislocation group (mean 55.3°) than the anterior dislocation (mean 11.6°) and no dislocation groups (mean 5.0°). There was no re-ankylosis after mobilization and the mean postoperative active range of motion (ROM) was 86.5°. The mean active ROM was 75.7° in the posterior dislocation group, 96.1° in anterior dislocation group and 100.0° in no dislocation group. The mean active supination was 6.9, 33.9 and 47.5° respectively. The posterior dislocation group showed less ROM and less supination than other groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM (ρ = − 0.59) and postoperative supination (ρ = − 0.73).

      Conclusion

      The mean postoperative active ROM of this mobilization was 86.5°. Posterior dislocation group showed higher pronation ankylosis angle preoperatively, and less postoperative ROM and less supination than anterior and no dislocation groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM and supination.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cleary J.E.
        • Omer G.E.
        Congenital proximal radio-ulnar synostosis. Natural history and functional assessment.
        J Bone Joint Surg Am. 1985 Apr; 67: 539-545
        • Green W.T.
        • Mital M.A.
        Congenital radio-ulnar synostosis: surgical treatment.
        J Bone Joint Surg Am. 1979 Jul; 61: 738-743
        • Hwang J.H.
        • Kim H.W.
        • Lee D.H.
        • Chang J.H.
        • Park H.
        One-stage rotational osteotomy for congenital radioulnar synostosis.
        J Hand Surg Eur. 2015 Oct; 40: 855-861
        • 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 Mar; 14: 81
        • Kanaya F.
        Mobilization of congenital proximal radio-ulnar synostosis: a technical detail..
        Tech Hand Up Extrem Surg. 1997 Sep; 1: 183-188
        • Kanaya F.
        • Ibaraki K.
        Mobilization of a congenital proximal radioulnar synostosis with use of a free vascularized fascio-fat graft.
        J Bone Joint Surg Am. 1998 Aug; 80: 1186-1192
        • Oka K.
        • Doi K.
        • Suzuki K.
        • Murase T.
        • Goto A.
        • Yoshikawa H.
        • et al.
        Vivo three-dimensional motion analysis of the forearm with radioulnar synostosis treated by the Kanaya procedure.
        J Orthop Res. 2006 May; 24: 1028-1035
        • Sakamoto S.
        • Doi K.
        • Hattori Y.
        • Dodakundi C.
        • Montales T.
        Modified osteotomy (Kanaya's procedure) for congenital proximal radioulnar synostosis with posterior dislocation of radial head.
        J Hand Surg Eur. 2014 Jun; 39: 541-548
        • Kanaya K.
        • Iba K.
        • Yamashita T.
        Long-term results after 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 Aug; 25: 1258-1267
        • Tsumura T.
        • Matsumoto T.
        • Matsushita M.
        • Kishimoto K.
        • Murase T.
        • Shiode H.
        A three-Step method for the treatment of radioulnar synostosis with posterior radial head dislocation.
        J Hand Surg Asian Pac. 2021; 26 (Mar): 118-125
        • Bauer M.
        • Jonsson K.
        Congenital radioulnar synostosis: radiological characteristics and hand function.
        Scand J Plast Surg. 1988; 22: 251-255
        • Miura T.
        • Nakamura R.
        • Suzuki M.
        • Kanie J.
        Congenital radio-ulnar synostosis.
        J Hand Surg Br. 1984 Jun; 9: 153-155
        • Miyagi Y.
        • Nakasone M.
        • Kinjo M.
        • Okubo H.
        • Futenma C.
        • Kanaya F.
        Evaluation of ADL before and after mobilization of a congenital proximal radio-ulnar synostosis.
        J Jpn Elbow Soc. 2018; 25 ([in Japanese)]): 38-42
        • Wegmann K.
        • Dargel J.
        • Burkhalt K.J.
        • Brüggemann G.P.
        • Müller L.P.
        The Essex-Lopresti lesion.
        Strategies Trauma Limb Reconstr. 2012 Nov; 7: 131-139
        • Nakasone M.
        • Nakasone S.
        • Kinjo M.
        • Murase T.
        • Kanaya F.
        Three-dimensional analysis of deformities of the radius and ulna in congenital proximal radioulnar synostosis.
        J Hand Surg Eur. 2018 Sep; 43: 739-743
        • Tsuji T.
        • Liu M.
        • Hanayama K.
        • Sonoda S.
        • Chino N.
        ADL structure for nondisabled Japanese children based on the functional independence measure for children (WeeFIM).
        Am J Phys Med Rehabil. 1999 May-Jun; 78: 208-212