Congenital Radioulnar Synostosis

Allan E. Peljovich and Peter M. Waters

History and Clinical Presentation

An otherwise healthy 19-month-old girl presented because her parents noticed that she was unable to eat with her left hand, and had difficulties with her right. Her mother's pregnancy was remarkable only for a cesarean section delivery 6 weeks preterm. She was noticed at birth to have bilateral inguinal hernias, both of which had since been repaired. Although she has been low in her percentiles for both height and weight, her development has been normal. Her mother is not sure which hand is her dominant one, but she seems to rely more on her left.

Physical Examination

Her complete musculoskeletal examination was unremarkable with the exception of her upper extremities. Her left elbow lacked ~10 degrees of extension. This elbow was fixed in ~90 degrees of pronation. The left wrist was rather supple and gave her 60 degrees of pronation and supination through the carpus. Her right elbow flexed and extended fully, and was held in ~45 degrees of pronation. Unlike in the left arm, there was a minor degree of forearm pronation and supination in the right arm. The right wrist was equally supple to the left.

Diagnostics Studies

Anteroposterior (AP) and lateral radiographs were available for both forearms/ elbows (Fig. 81—1). She had a complete proximal bony synostosis of the left proximal radius and ulna. The synostosis involved the entire aspect of the proximal forearm, including the radial head and the proximal radioulnar joint. The radial head was posterior to the capitellum. There was a partial synostosis proximally of the right forearm with evidence of a foreshortened, and posteriorly dislocated radial head.

Figure 81—1. Initial radiographs. Anteroposterior (AP)film of the left forearm (the operative side).

Radioulnar Synostosis

Figure 81—1. Initial radiographs. Anteroposterior (AP)film of the left forearm (the operative side).

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