CONGENITAL PROXIMAL RADIOULNAR SYNOSTOSIS - SURGICAL-TREATMENT

Twenty-two patients (26 synostoses) surgically treated at the Istituto Ortopedico Rizzoli were evaluated. These synostoses were divided into three radiographic types: ''partial'' or type 1, ''complete'' or type 2, and ''extended'' or type 3. After critical analysis of the results obtained by different treatments, we conclude that operative treatmen t is indicated only when synostosis is so severe that effective compen sation by the shoulder and the wrist joints is impossible; this occurs only in radiographic type 2 and 3 in which pronation is >60-degrees. Pronation <30-degrees, which almost always corresponds to type 1, shou ld not be surgically corrected because such patients have little or no functional limitation of the upper extremity. In intermediate cases ( 30-degrees-60-degrees), the indication for operation should be evaluat ed case by case based on the following parameters: bilaterality, invol vement of the dominant side, psychological and cosmetic aspects and, i n particular, the efficacy of compensatory mechanisms. In patients wit h <70-degrees of pronation the Sever (5) and Green and Mital (4) metho ds are both appropriate. For more severe cases, transverse osteotomy a t the synostosis level is indicated to avoid neurovascular lesions. Do uble osteotomy (proximal and distal) is indicated for very severe case s in which the desired correction cannot be obtained by either of the other methods.