[Rotational osteotomy technique for congenital radio-ulnar synostosis with central medullary nailing and external...

Congenital radio-ulnar synostosis is a very uncommon condition. The functional impairment resulting from the complete pronation posture justifies rotational osteotomy. We present a series of six rotational osteotomies using the Hernigou-Goutallier technique.

The Hernigou-Goutallier osteosynthesis procedure is based on a centromedullary nail and two external fixation pins positioned in the ulna at an angle corresponding to the desired rotation. The nail is partially withdrawn to allow subperiosteal osteotomy in the synostosis via a horizontal incision between the two pins. After rotation, the osteotomy is stabilized with clamps holding the external fixation pins in parallel.

Bone healing was achieved at two months in all six cases with no loss of correction.

Among the different treatments proposed for radio-ulnar synostosis, the risk of vessel or nerve injury is high with screw-plate fixation despite shortening osteotomy. Palm-tree osteotomy raises the same risks and is more invasive and difficult to achieve. The rotational osteotomy technique presented here has the advantage of allowing local care more easily than with cast fixation. Another important advantage is that an overcorrection leading to vessel or nerve injury can be reversed without losing the axis, allowing progressive correction if necessary.