Radioulnar Synostosis After the Two-Incision Biceps Repair: A Standardized Treatment Protocol

Author(s): Sotereanos DG, Sarris I, Chou KH

Source:  Journal of Shoulder and Elbow Surgery 13: 448-453, 2004.

Summary:

This study examines the use of a posterolateral incision with the use of post-operative radiation therapy to restore rotation in patients who developed a radioulnar synostosis following a biceps tendon repair.   The authors included eight patients who developed radioulnar synostosis post-operatively.  The mean time between tendon repair and resection of synostosis was 7 months. The decision to operate was made when radiographs demonstrated mature lamellar bone by plain films. The authors did not use alkaline phosphatase or perform bone scans, which is consistent with current literature.  From a surgical perspective, the majority of the synostoses were located more volarly between the radius and the ulna. The synostoses were exclusively between the radius and ulna and did not bridge the elbow joint.  The authors do note that they performed a neurolysis of the posterior interosseous nerve prior to resection of the heterotopic bone. Bone wax was placed, but there was nointerposition material placed.

Post-operatively, the patients were treated with radiation therapy consisting of a dose the morning after surgery of 350cGy. The second dose was administered the afternoon the day after surgery, again 350cGy. The authors did not use anti-inflammatory medication. The results were notable for excellent improvement in arc of motion with a restoration of 155 degrees at 27 months.  This paper underscores the potential for the development of radioulnar synostosis following repair of the distal biceps tendon.  It has been shown with one incision techniques as well.  The best treatment for heterotopic bone may be prophylaxis, and one should consider non-steroidal anti-inflammatory agents for a short period following this surgical procedure.  Nonetheless, when it occurs, restoration of forearm rotation is possible with resection of the bony bridge.  This is a very difficult surgical procedure that requires safe exposure, fluorooscopy and experience.

 

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Journal of Shoulder and Elbow Surgery 13: 448-453, 2004.