This study evaluated the long-term results of more than 10 years of a simple rotational osteotomy technique for correcting pronation deformity in congenital radioulnar synostosis. The technique involved performing an osteotomy only across the radius shaft. In 12 forearms of 9 patients followed for an average of 13.6 years, the technique achieved an average motion arc from 26 degrees of pronation to 62 degrees of supination. All patients were satisfied with the results and reported improved ability to perform daily activities. The study concluded that rotational osteotomy of the radius is an effective, reliable, and safe method for correcting pronation deformity in congenital radioulnar synostosis.

1. Long-term results after simple rotational osteotomy of the radius
shaft for congenital radioulnar synostosis
桡骨干简单旋转截骨术为了先天性尺桡骨性连接的远期疗效
Department of Orthopaedic Surgery, Yamagata Saisei Hospital, Yamagata, Japan e Hand, Elbow and Sports
Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
Presenter: ANIL KC
GUANGXI MEDICAL UNIVERSITY

2. Introduction/简介
• Congenital radioulnar synostosis (CRUS) is an uncommon malformation. Most patients have a
condition in which the forearm is fixed in pronation. This may cause severely disabling functional
impairment such as inability to scoop up water in the hands, to use a fork or chopsticks, or to
drink water from a glass. In older children, the chief complaints are often difficulty in sports.
• 先天性尺桡骨性连接（CRUS）是一种罕见的畸形。大多数病人都有前臂旋前固定的情况。
这可能会导致严重的功能障碍，如无法用手舀水、使用叉子或筷子、或从玻璃杯喝水。在
大一点的孩子中，主要的抱怨是运动上的困难

3. Introduction/简介
• Rotational osteotomy of the forearm bones or a surgical procedure to mobilize
the fused joint is recommended to achieve a more functional position.
Osteotomy is usually done through the fusion mass, but the operative procedure
for adequate correction is relatively complicated.
• 前臂骨的旋转截骨术或移动融合关节的手术程序被推荐以获得更具功能性的
位置。截骨术通常是通过融合块来完成的，但适当校正的手术程序相对复杂。

4. Introduction/简介
• To prevent these complications, Kashiwa et al developed a simple method for correction of the
forearm position in which osteotomy was performed only across the shaft of the radius. Horii et al.
reported good results of single osteotomy at the radial diaphysis using temporary fixation with
Kirshner wire. Although these procedures were relatively simple, the long-term outcomes were not
described. Here they report the long-term (≥10 years) results of simple rotational osteotomy for
CRUS without use of an implant.
• 为了预防这些并发症，Kashiwa et al 开发了一种简单的办法为了校正前臂位置，其中仅在桡
骨干上进行截骨。Horii et al 报道了用 K wire 暂时固定桡骨干的单次截骨术的良好效果。虽然
这些手术相对简单，但没有描述长期结果。在这里他们报告了不使用内固定的简单旋转截骨
术的长期（≥10年）结果。

5. Material and method/材料和方法
• Between 1998 and 2006, 12 forearms in 9 Asian patients (6 boys and 3 girls; average age, 6.4 years;
range, 4-10 years) underwent simple rotational osteotomy for CRUS performed by a single surgeon
and were monitored for an average of 13.6 years (range, 10-19 years). In 3 of the patients, both
forearms were involved. The average preoperative degree of fixed forearm pronation was 51.3°
(range, 30°-90°). The postoperative (true) forearm position, the palm pronation and supination
angles at 90° of elbow flexion, and complications were measured.
• 1998年至2006年间，9名亚洲患者（6男3女；平均年龄6.4岁；范围4-10岁）的12个前臂接受了
由一名外科医生进行的简单旋转截骨术，平均接受了13.6年（范围10-19岁）的监测。其中3例
患者双侧前臂受累。前臂固定旋前平均51.3°（30°-90°）。测量术后（真实）前臂位置、肘关
节屈曲90°时手掌旋前和旋后角及并发症。

6. Material and method/材料和办法
• Eight patients were asked to subjectively evaluate the degree of improvement in
their activities of daily living (ADL) with a mean follow-up of 5.2 years (range, 1-10
years) after surgery. They have evaluated 26 ADL items as shown in table below.
• 8例患者术后平均随访5.2年（1～10年），主观评价日常生活能力（ADL）的
改善程度。他们已经评估了26个ADL项目，如下表所示。

7. Material and method

8. Surgical method/手术办法

9. Surgical method/手术办法

10. Results/结果
• After surgery, the forearm was fixed at an average of 4° of supination. At the final follow-up, the
palm was able to achieve an average motion arc ranging from 26° of pronation to 62° of
supination. There were no neurologic or circulatory complications after surgery. Ability to perform
daily activities was markedly improved, and all patients were satisfied with the results of surgery.
The average score on the 11-item version of the Disability of the Arm, Shoulder, and Hand was
3.79 points at the final follow-up.
• 术后前臂固定在平均旋后4°。在最后的随访中，手掌能够达到26°旋前到62°旋后的平均运动
弧度。术后无神经或循环系统并发症。日常活动能力明显提高，所有患者对手术结果满意。
在最终的随访中，11个项目的手臂、肩膀和手的残疾平均得分为3.79分。

11. Result/结果

12. Result/结果

13. Result/结果

14. Result/结果

15. Result/结果

16. Discussion/讨论
• This study had several limitations.
• It was based on a retrospective review with a small number of patients and lacked a control group.
• Only 1 of the authors performed the measurement of forearm position, palm pronation, and
supination angles.
• Assessing the true range of supination and pronation in patients with CRUS is difficult.
• 这项研究有几个局限性
• 这是基于对少数患者的回顾性研究。
• 只有1位作者进行了前臂位置、手掌旋前和旋后角度的测量。
• 评估这些东西困难的。

17. Conclusion/结论
• The investigation of long-term results (over 10 years) of simple rotational osteotomy for congenital
radioulnar synostosis was performed . All 9 patients (12 forearms) were satisfied with the results of
the operation. Rotational osteotomy of the radius is simple, reliable, satisfactory, and safe for
correcting pronation deformity in congenital radioulnar synostosis.
• 对10年以上简单旋转截骨术治疗先天性尺桡骨性连接的远期疗效进行了分析。9例患者（12个
前臂）对手术结果满意。桡骨旋转截骨术治疗先天性尺桡骨性连接旋前畸形简单、可靠、满意、
安全。

18. 谢谢