[Surgery of congenital radio-ulnar synostosis. Technical error and therapeutic strategy]

A clinical feature of surgery in congenital radioulnar synostosis is described.

A eighteen year old right handed woman, was hampered when she works by a left congenital radio ulnar synostosis. Clinical examination showed a left forearm locked in 75 degrees of pronation. Radiographs showed a proximal synostosis. Surgical treatment associated a resection of the synostosis with silastic interposition, resection of the distal end of the ulna, and derotational middle-third osteotomy of the radius.

Three months later, the pronosupination was 90 degrees, but an ischemic retraction of the flexor pollicis longus muscle appeared with a non-union of the radius. A second procedure was necessary to put a plate in compression on bone and to release the muscle. Twenty years later, the forearm was locked in neutral pronosupination, without recurrence of synostosis on radiographs.

Surgical treatment in congenital radio ulnar synostosis associates many problems: indication (often for discomfort), ideal age (more vascular or nervous post operative complications if older), technical (failure of operations with functional aim).

A review of international litterature allows the authors to suggest a specific management for congenital radio ulnar synostosis.