Gradual correction of congenital radioulnar synostosis by an osteotomy and Ilizarov external fixation.

PURPOSE: To report the method, outcome, and complications with Ilizarov external fixation for correction of congenital radioulnar synostosis with fixed forearm pronation greater than 60°.

METHODS: We treated 4 patients with an average age of 11 years (range, 9-13 y). Three patients had bilateral deformity and 1 had deformity of the right forearm only. All forearms were classified as type 3 according to Cleary and Omer. Indications were severe (> 90°) bilateral pronation deformity in 3 patients, with a mean preoperative pronation deformity of 100° (range, 90° to 110°), whereas 1 patient had unilateral right forearm deformity treated for cultural reasons. All patients underwent osteotomy at the level of the synostosis and gradual correction of the deformity using an Ilizarov external fixation device.

RESULTS: Mean supination position of the forearms after the correction was 15° (range, 0° to 30°). Two patients experienced neurapraxia of the radial nerve attributed to acute initial partial correction of the deformity in the operating room; the correction was returned to its original position, resulting in complete neurological recovery. One patient experienced a pin track infection, which we treated successfully with oral antibiotics.

CONCLUSIONS: Our small series demonstrated the ability to gradually correct forearm rotation deformities greater than 90° using Ilizarov external fixation devices.