Functional results of surgical treatment of congenital superior radio-ulnar synostosis in children by muscle transfer and derotational osteotomy

ABSTRACT

This study was performed to evaluate the functional results of surgical treatment of congenital superior radio-ulnar synostosis [SRUS] in children by Anconeus muscle transfer and derotational osteotomy. Patients diagnosed as having SRUS presented to the outpatient clinic of the Suez Canal University Hospitals between august 2003 to October 2006. 6 patients were included in the study as 4 males and 2 females, and two male patients had bilateral deformity with the total number of deformed SRU joint of 8. The average age was 4.8 [3-8] years. History taking about the functional deficit caused by this deformity and local examination of the affected elbow joint for evaluation and measurement of the range of motion of flexion and extension, supination and pronation movement. The position of the forearm and if it is a bilateral deformity was also evaluated and measured. Pre-operative plain x-ray was done for every patient for evaluation of the degree of the synostosis and if there is any other consequent deformities such as bowing of the radius. Anconeus muscle transfer and derotational osteotomy of the distal radius was done for all patients and post-operative evaluation through x-rays and clinical evaluation for the range of supination and pronation was done and at one year of follow-up. All patients had fixed pronation deformity of the forearm pre-operatively at 70 degrees [ranged from 60 to 80 degrees] and this position causes functional disability. Post-operatively, they had a range of motion with the degree of supination as 30 degrees [range from 20 to 40 degrees], and the degree of pronation is 60 degrees [range from 40 to 70 degrees] and the range of motion was assessed after one year and all patients had decrease of the range of supination and pronation in different degrees as the supination was 25 degrees [ranged from 10 to 40 degrees] and the pronation was 40 degrees [ranged from 35 to 55 degrees]. Surgical treatment of congenital superior radio-ulnar synostosis in children using the Anconeous muscle as an interpositional material prevented recurrence of the ankylosis and improving rotation of the forearm. Also, derotational osteotomy of the radius will prevent dislocation of the radial head and this will improve rotation of the forearm as well. In addition this technique is more easy than other procedures and has less complications