Rotation Restored: Fascia Lata Interposition for Proximal Radioulnar Synostosis after Olecranon Plating

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Biomaterials

Background:

• Proximal radioulnar synostosis (PRUS) causes significant forearm rotation loss after fractures and surgery.
• Current treatments involve surgical excision, but recurrence is common without interposition barriers.
• Autologous tensor fascia lata (TFL) grafts offer a biologic solution for interposition, restoring rotation with minimal donor site morbidity.

Purpose of the Study:

• To evaluate the efficacy of tensor fascia lata (TFL) interposition for treating post-traumatic proximal radioulnar synostosis (PRUS).
• To assess surgical technique, functional outcomes, recurrence rates, graft integration, and heterotopic ossification (HO) prophylaxis.
• To present original cohort data alongside a comprehensive review of existing literature.

Main Methods:

• Retrospective observational study of a consecutive cohort treated between 2017 and 2024.
• Surgical intervention involved complete extraperiosteal excision of the synostotic mass with TFL graft interposition.
• Focus on standardized graft fixation, early mobilization, and HO prophylaxis.

Main Results:

• Demonstrated successful radiologic graft integration and low donor-site morbidity.
• Observed uncommon recurrence rates and significant improvements in pronation-supination and functional scores.
• Confirmed the effectiveness of TFL interposition when combined with meticulous surgical technique and rehabilitation.

Conclusions:

• Excision with autologous TFL interposition is a reliable method for restoring forearm rotation in PRUS.
• Standardized protocols for graft selection and preventive regimens require further investigation through multicenter trials.
• This approach offers a dependable solution for managing PRUS, improving patient function and quality of life.