[Surgery of congenital radio-ulnar synostosis. Technical error and therapeutic strategy].
PURPOSE OF THE STUDY: A clinical feature of surgery in congenital radioulnar synostosis is described. MATERIAL AND METHODS: 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. RESULTS: 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. DISCUSSION: 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). CONCLUSION: A review of international litterature allows the authors to suggest a specific management for congenital radio ulnar synostosis.