This study is a retrospective review of seven patients treated with proximal radial resection for proximal radioulnar synostosis. A one-centimeter segment of radius was resected just distal to the synostosis via a Kocher approach in six patients and a Thompson approach in one patient. Various interposition materials were utilized, including bone wax, gelfoam, and anconeus muscle. Post-operative therapy included continuous passive motion (CPM) therapy for 48 hours, followed by alternating static splints for a minimum of three months. The mean time from original trauma to operative intervention was 123 months (range, 6 to 600 months). Final follow-up evaluation was 80 months (range, 24-144 months). Forearm rotation increased from 0 degrees preoperatively in all patients to an average arc of 129 degrees (range, 100 degrees to 155 degrees) intra-operatively, to a final arc of motion of 98 degrees (range, 40 degrees to 175 degrees) at final evaluation. Only 2 of 7 patients had achieved a flexion-extension arc of 30-130 degrees. Three patients underwent an examination under anesthesia due to limited motion at 1-month post operation and one of these required a formal manipulation. There were no major complications. The mean resection gap measured on plain radiographs was 6.8mm immediately post-operatively and 4.7mm at latest follow-up.
The authors report that this technique is not indicated for patients with a resectable synostosis and is not indicated in the presence if a chronic Essex-Lopresti injury. They felt that bone wax placed at the resection site positively influenced the outcome, but their numbers were too small to provide statistical evidence. Only one re-ankylosis occurred despite only 3 patients receiving prophylaxis with indomethacin (n=2) or radiation therapy (n=1). This technique appears to be a viable surgical option in patients with an extensive synostosis of the proximal radius and ulna that is unresectable with an intact ulnohumeral joint and no evidence for a chronic Essex-Lopresti lesion. The vast majority of these cases, however, can be treated by resection, reestablishing normal forearm anatomy. When resecting an ankylosis or performing this procedure, the optimal interposition material is still not defined. Similarly, the absolute need for adjuvant heterotopic ossification prophylaxis is not entirely clear, although some form of prophylaxis would seem reasonable.
J Bone Joint Surg