OPERATIVE TREATMENT OF POSTTRAUMATIC PROXIMAL RADIOULNAR SYNOSTOSIS

The results of operative resection of a post-traumatic proximal radiou lnar synostosis performed by one surgeon in eighteen limbs of seventee n consecutive patients during an eight-year period were reviewed retro spectively, The resection was performed an average of nineteen months after the injury; eight limbs had the resection less than twelve month s after the injury, A free fat graft was used in the first eight patie nts, No adjuvant non-steroidal anti-inflammatory medication or low-dos e radiation was used postoperatively as prophylaxis against heterotopi c ossification, We classified the proximal radioulnar synostoses into three subgroups: A indicated a synostosis at or distal to the bicipita l tuberosity (four limbs), B indicated a synostosis involving the radi al head and the proximal radioulnar joint (seven limbs), and C indicat ed a synostosis that was contiguous with bone extending across the elb ow to the distal aspect of the humerus (seven limbs), The patients wer e followed for an average of thirty-four months (range, twenty-four to sixty months), The synostosis recurred in one patient, the only patie nt in the series who had sustained a closed head injury at the time of the initial injury, Additional complications included a fracture of t he ulna, a broken pin on a hinged elbow distracter, and dislodgment of a free nonvascularized fat graft in one patient each, The seventeen l imbs that did not have a recurrence regained an average of 139 degrees of rotation of the forearm, With the number of patients available, we could not detect a significant relationship between subsequent rotati on of the forearm and the size of the synostosis, the use of interposi tional fat, or the concomitant use of a hinged elbow distracter, The e ight limbs that had resection of the synostosis less than twelve month s after the injury regained an average of 144 degrees of rotation comp ared with 134 degrees in the nine limbs that had resection at least tw elve months after the injury, This difference could not be shown to be significant. In this series, operative resection of a post-traumatic proximal radioulnar synostosis led to good results despite the lack of adjuvant radiation therapy or antiinflammatory medication.