Reza Shahryar Kamrani1, Parviz Ahangar2, Mohammad Hossein Nabian3, Saeed Reza Mehrpour4, Leila Oryadi Zanjani4. 1. Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Orthopedic and Trauma Surgery, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran. 3. Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: Hamooooooon@yahoo.com. 4. Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Abstract
BACKGROUND: Proximal radioulnar synostosis is a complication after elbow injuries. Various treatment methods have been reported and are associated with unpredictable outcomes. In a prospective study, we evaluated the medium-term effects of proximal radial resection on wrist and elbow function and forearm rotation in 15 cases. METHODS: We treated 15 patients with posttraumatic proximal radioulnar synostosis by resection of 1 cm of the proximal radial diaphysis. On the preoperative examination and last follow-up, the Mayo Elbow Performance Score, grip force, visual analog scale for elbow and wrist score, radiographic ulnar variance changes, and elbow range of motion were measured. The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and the general satisfaction of the patients were assessed at the final follow-up. RESULTS: The mean duration of follow-up was 31 ± 13 months. The mean active postoperative supination/pronation arc was 101° ± 45°. The mean increase measured in the ulnar variance at the final follow-up was 3.3 ± 1.5 mm (P = .02). The mean final QuickDASH score was 13.3 ± 12.1. The preoperative and final Mayo scores were 57 ± 10 and 91 ± 7, respectively (P = .01). The general satisfaction with the results of the operation was 86.6%. CONCLUSIONS: We suggest that proximal radial resection for the treatment of posttraumatic proximal radioulnar synostosis shows acceptable results in adults regarding the recovery of range of motion and patient satisfaction. This technique might be considered as a salvage procedure, particularly in cases with previous failed heterotopic resection at the proximal radioulnar joint, resulting in disturbed anatomy. LEVEL OF EVIDENCE: Level IV, case series, treatment study.
BACKGROUND: Proximal radioulnar synostosis is a complication after elbow injuries. Various treatment methods have been reported and are associated with unpredictable outcomes. In a prospective study, we evaluated the medium-term effects of proximal radial resection on wrist and elbow function and forearm rotation in 15 cases. METHODS: We treated 15 patients with posttraumatic proximal radioulnar synostosis by resection of 1 cm of the proximal radial diaphysis. On the preoperative examination and last follow-up, the Mayo Elbow Performance Score, grip force, visual analog scale for elbow and wrist score, radiographic ulnar variance changes, and elbow range of motion were measured. The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and the general satisfaction of the patients were assessed at the final follow-up. RESULTS: The mean duration of follow-up was 31 ± 13 months. The mean active postoperative supination/pronation arc was 101° ± 45°. The mean increase measured in the ulnar variance at the final follow-up was 3.3 ± 1.5 mm (P = .02). The mean final QuickDASH score was 13.3 ± 12.1. The preoperative and final Mayo scores were 57 ± 10 and 91 ± 7, respectively (P = .01). The general satisfaction with the results of the operation was 86.6%. CONCLUSIONS: We suggest that proximal radial resection for the treatment of posttraumatic proximal radioulnar synostosis shows acceptable results in adults regarding the recovery of range of motion and patient satisfaction. This technique might be considered as a salvage procedure, particularly in cases with previous failed heterotopic resection at the proximal radioulnar joint, resulting in disturbed anatomy. LEVEL OF EVIDENCE: Level IV, case series, treatment study.