MOBILIZATION OF A CONGENITAL PROXIMAL RADIOULNAR SYNOSTOSIS WITH USE OF A FREE VASCULARIZED FASCIO-FAT GRAFT

We present the results of a new mobilization procedure for the treatme nt of a congenital proximal radioulnar synostosis in seven patients. T he operative procedure included separation of the synostosis and place ment of a free vascularized fascio-fat graft to prevent recurrent anky losis, The average age at the time of the operation was eight years an d two months (range, six years and four months to eleven gears and ten months). All of the patients were boys who had no other congenital an omalies. The radial head was dislocated in all seven patients (anterio rly in two and posteriorly in five). The final four index operations i ncluded an osteotomy of the radius in order to reduce the dislocated r adial head. The average duration of follow-up was three years and eigh t months (range, two years and four months to four years and five mont hs). Preoperatively, the patients had had difficulty with holding a bo wl of soup and accepting objects, such as coins, into the palm. Postop eratively, they were able to perform these activities. None of the pat ients had recurrent ankylosis or loss of the nap. The average supinati on was 26 degrees (range, 10 to 45 degrees), and the average pronation was 45 degrees (range, 10 to 80 degrees). The four patients who had h ad an osteotomly of the radius in addition to the index procedure did not have a dislocation of the radial head and had an average are of mo tion of 83 degrees of pronation and supination, The three patients who had not had an osteotomy had a dislocation of the radial head and an average are of motion of 40 degrees after the index procedure. These f indings demonstrate that separation of a congenital radioulnar synosto sis with a vascularized fascio-fat graft and osteotomy of the radius c an achieve pronation and supination of the forearm.