1/12. Surgical treatment of posttraumatic radioulnar synostosis in children.The authors describe two children who underwent surgical treatment of radioulnar synostosis. One case involved simple excision; the other, excision and interposition of Gore-Tex vascular graft material. In a review of the literature, no other report of the latter type of surgical treatment was found. A discussion of the literature concerning this rare complication in children and the current surgical treatment options are included.- - - - - - - - - - ranking = 1keywords = synostosis (Clic here for more details about this article) |
2/12. Posttraumatic radioulnar synostosis treated with a free vascularized fat transplant and dynamic splint: a report of two cases.Two cases of posttraumatic radioulnar synostosis are presented. The patients were treated with excision of the cross-union and interposition of a free vascularized fat transplant. A newly devised pronation-supination dynamic splint was employed for 3 months postoperatively in both patients. After a 1-year postoperative follow-up, an increased range of motion was restored in both cases, and there was no evidence of recurrent synostosis formation in subsequent radiographs. We suggest that an interposed vascularized fat graft may be an ideal biologic barrier to fill the space created by cross-union excision.- - - - - - - - - - ranking = 1.2keywords = synostosis (Clic here for more details about this article) |
3/12. Correlation of postoperative bone scintigraphy with healing of vascularized fibula transfer: a clinical study.This study examines the usefulness and reliability of bone scintigraphy in correlation with radiological and clinical evidence of bone healing in 15 patients who underwent microvascular transfer of the fibula. All patients were followed for a minimum of 18 months postoperatively. technetium-99 methylene diphosphonate bone scans and the most recent radiographs were blindly rereviewed. Bone scintigraphic results were characterized as (1) clearly positive (i.e., excellent visualization of the fibula), (2) clearly negative (i.e., no evidence of tracer uptake in the fibula), or (3) indeterminate (i.e., artifact present as a result of metallic or soft tissue interference). Bone radiographs were classified into three typical patterns: (1) complete bony union and graft hypertrophy, (2) incomplete union (either distal or proximal) requiring a second procedure), and (3) nonunion, with increased proximal and distal lucency (with or without pathological fracture) and loss of graft definition. Eleven patients had positive scintigraphic scans postoperatively. In 8 no subsequent procedure was necessary; 2 patients required additional bone grafts to augment the osseous reconstruction; viable fibulas were seen at reoperation. One patient with a positive scan showed decreased graft definition at four months followed by autograft fracture. Three patients had indeterminate scans, 2 of whom evidenced uncomplicated clinical and radiological union. One patient had a clearly negative scan and ultimately tibia-fibula synostosis was required to attain stability. Bone scintigraphy appears to correlate with survival, but not necessarily union, of a vascularized fibula autograft. Additional monitoring techniques should be used in combination with a one-time bone scan to both monitor the patency of the microanastomoses and to prioritize the orthopedic management of the patient.- - - - - - - - - - ranking = 0.2keywords = synostosis (Clic here for more details about this article) |
4/12. Radioulnar synostosis following proximal radial fracture in child.A case is presented with an eight-year follow-up of a proximal radial fracture complicated by radioulnar synostosis. The case and a review of the literature reveal that the complication is associated with certain risk factors. These factors include a fracture in a child over ten years of age with a severe degree of angulation, displacement uncorrected over 4 mm, concomitant posterior dislocation of the elbow, treatment by open reductions supplemented with transcapitellar wires, and a fracture treated by late open reduction without osteotomy.- - - - - - - - - - ranking = 1keywords = synostosis (Clic here for more details about this article) |
5/12. Post-traumatic radioulnar synostosis. A report of two cases.In two cases of post-traumatic radioulnar synostosis occurring in a father and his adult son, the bony bridge was excised and a Silastic sheet interposed between the forearm bones. Both patients benefitted and had improved function of the hand following the procedure, although the range of forearm rotation restored was limited. The question is raised as to whether trauma triggers the expression of a latent familial tendency to synostosis of the radius and ulna in these cases.- - - - - - - - - - ranking = 1.2keywords = synostosis (Clic here for more details about this article) |
6/12. Traumatic radio-ulnar synostosis treated by excision and a free fat transplant. A report of two cases.The operative technique and result of treatment of traumatic radio-ulnar synostosis in two patients are described. In both, the treatment was excision of the cross-union and interposition of a free non-vascularised fat transplant. The functional result was excellent, and there was no evidence of regrowth of the synostosis at two and three years respectively.- - - - - - - - - - ranking = 1.2keywords = synostosis (Clic here for more details about this article) |
7/12. Treatment of traumatic radioulnar synostosis by excision and postoperative low-dose irradiation.Post-traumatic radioulnar synostosis can have a profound effect on upper extremity function. Prior reports of excision, with and without interposition material, have demonstrated frequent recurrence and disappointing results. Based on a favorable experience with radiation prophylaxis of heterotopic ossification following total hip arthroplasty, this modality has been used in the management of post-traumatic forearm synostosis. Four cases using excision of bony synostosis followed by single-fraction, low-dose (800 cGy), limited-field irradiation are presented. With a follow-up period of 1-4 years after excision and irradiation, all four patients had total arcs of forearm rotation between 115 degrees and 120 degrees. Each patient noted sustained functional improvement, and there was no x-ray film evidence of recurrent synostosis formation. Single fraction irradiation did not require ongoing patient compliance nor did it complicate rehabilitative efforts. Furthermore, soft tissue and bony healing were not impaired.- - - - - - - - - - ranking = 1.6keywords = synostosis (Clic here for more details about this article) |
8/12. Post-traumatic radio-ulnar synostosis treated by surgical excision and adjunctive radiotherapy.The management of three cases of traumatic radio-ulnar synostosis involved surgical excision of the synostotic bone followed by radiotherapy. Irradiation was commenced on the first postoperative day and was continued daily. The first patient received 20 Gy midline in 10 fractions and the second and third patients 10 Gy in five fractions. No acute side effects were observed. All three patients regained a good, functional range of forearm rotation with no evidence of recurrence of the synostosis after 2 years. This method of treatment is recommended as an alternative to other adjunctive therapies including interposition of material such as silicone sheet between the bones or peri-operative pharmacological suppression.- - - - - - - - - - ranking = 1.2keywords = synostosis (Clic here for more details about this article) |
9/12. Radio-ulnar synostosis following external fixation.Post-traumatic radio-ulnar synostosis is an unusual but serious complication of adult forearm fractures. This is the first report of radio-ulnar synostosis following external fixation to be described in the English literature. A 52-year-old man sustained a fracture of the distal radius and ulna which was managed by external fixation. Following this, he developed a radio-ulnar synostosis at the pin-track site. The synostosis was successfully removed and he regained significant rotatory movement of his forearm.- - - - - - - - - - ranking = 1.6keywords = synostosis (Clic here for more details about this article) |
10/12. Pin-site radioulnar synostosis after external fixation of a distal radial fracture: two case reports.Complications of distal radial fracture and external fixation are common, but the authors report, in two patients, a previously unrecognized complication, that of radioulnar synostosis. In both cases the proximally placed pins extended across the interosseous region, and the distal ends were adjacent to the ulna. hematoma and osseous debris were introduced into the interosseous region. Several weeks after the external fixator was removed, the patients were noted to have a restricted range of pronation and supination. A radioulnar synostosis had formed across the interosseous region. Resection of the synostosis restored pronation and supination. With careful pin placement this complication will be avoided.- - - - - - - - - - ranking = 1.4keywords = synostosis (Clic here for more details about this article) |
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