Updated: 5/24/2021

Radioulnar Synostosis

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  • Introduction
    • Bony bridge which develops between radius and ulna secondary to a specific event
      • must differentiate from congenital radioulnar synostosis
  • Epidemiology
    • Incidence
      • 3% to 9%
    • Risk factors
      • trauma related
        • Monteggia fracture
        • both bone forearm fractures at the same level
        • open fracture,
        • significant soft-tissue lesion
        • comminuted fracture
        • high energy fracture
        • associated head trauma
        • bone fragments on the interosseous membrane
      • treatment related
        • use of one incision for both radius and ulna
        • delayed surgery > 2 weeks
        • screws that penetrate interosseous membrane
        • bone grafting into interosseous membrane
        • prolonged immobilization
  • Anatomy
    • Forearm anatomy
  • Presentation
    • History
      • previous trauma or surgery in forearm
    • Symptoms
      • pain with incomplete synostosis
      • no pain with complete synostosis
    • Physical exam
      • pronation and supination blocked both actively and passively
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral of forearm, elbow, and wrist
      • findings
        • bony bridge between radius and ulna
  • Treatment
    • Operative
      • surgical resection of synostosis, irradiation, and indomethacin
        • indications
          • mature post-traumatic synostosis that impairs function
          • excision indicated at 4-6 months
            • timing is controversial
              • excision too early can lead to recurrence
              • excision too late can lead to surrounding joint contractures
        • results
          • results of resection are poor except for midshaft synostosis
      • proximal radial excision
        • indications
          • reserved for patients who have a proximal radioulnar synostosis that is too extensive to allow a safe resection, involves the articular surface, and is associated with an anatomic deformity.
        • results
          • can provide forearm rotation
          • associated with radioulnar and/or elbow instability
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