[Surgical treatment of isolated, congenital radio-ulnar synostoses]

The form of surgical treatment mainly considered for treatment of radioulnar synostoses is corrective osteotomy of severe malpositions of the forearm. Opinions as to the indications for such surgery range from complete rejection to regular application in cases with pronounced contractures. In the present article, the authors consider solely isolated congenital radioulnar synostoses, referring to 40 cases in 30 patients. In 13 cases the condition was bilateral. Roentgenologically, four degrees of severity may be distinguished: in the mildest form, there are only dysplasias in the proximal radioulnar joint. Second-degree malformation is characterized by synostoses exclusively in the proximal radioulnar joint. In third-degree synostoses the bony bridges extend farther distalward. In the rare fourth-degree form of the anomaly, complete or almost complete bridges are found between the two forearm bones. On the basis of the clinical findings, the authors give their views on the question of corrective surgery, the key factor being findings deriving from carefully conducted physiotherapeutic and ergotherapeutic function tests. In view of the fact that even in cases of pronounced bilateral contracture most actions are accomplished by compensatory movement of the shoulder and wrist joints, and considering the relatively high complication rates reported in the literature, the authors are in principle against surgery. If, in exceptional cases with extreme malposition, correction is nevertheless considered following thorough function testing, 30-40 degrees pronation of the forearm on the dominant side and slight supination on the non-dominant side are recommended.