[Post-traumatic proximal radioulnar synostosis. Surgical technique and review of the literature]

Release of Extensive Post Traumatic Radio-Ulnar Synostosis with Vascularized Free Flap Interposition

Radioulnar synostosis is a rare complication after a forearm or elbow injury. The severity of initial trauma, associated head injury along with timing and the type of surgical treatment have been implicated in the formation of extra bone leading to synostosis. Surgical intervention is the standard treatment and is recommended after the maturation of synostotic bone. Surgery involves resection of the extra bone with or without tissue interposition. Materials used for interposition may include synthetic materials, allografts, and vascularized and non-vascularized autologous tissue superiority of one material over the other has not been demonstrated. Reported is a case of extensive soft-tissue defect and severe type II synostosis, with a relevant review of the literature. Level of Evidence Level IV.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-021-00395-5.

[Monteggia-fractures and Monteggia-like Lesions]

Monteggia lesions and Monteggia-like lesions involve ulna and radius injuries, which can not be successfully treated using the surgical principles of isolated fractures. Proximal ulnar fracture, radio-humeral dislocation, and additional dislocation in the proximal radioulnar joint result in the disintegration of the functional unit, and there is a complex injury across the elbow to the forearm, resulting in poor clinical outcomes. Thus, addressing all osteo-ligamentous injuries is essential for the long-term course.

[Corrective osteotomies around the elbow in childhood and adolescence : Indications and techniques for posttraumatic deformities]

Evidence-based literature on counseling and treatment of pediatric and adolescent patients with posttraumatic deformities is scarce; however, especially around the elbow with its low remodeling potential, the number of patients with malunions presenting in outpatient clinics is not rare at all. In this review the more frequent indications for corrective surgery around the pediatric elbow are described and treatment proposals are made from the perspective of an interregional reference center for pediatric and adolescent trauma.

The Posttraumatic Proximal Cross-union of the Forearm in Childhood: What is Recommended?

The posttraumatic proximal cross-union of the forearm in childhood is a rare complication after radial head, neck or proximal forearm fractures and elbow dislocations. There is no standardized treatment. Several surgical procedures with or without interposition techniques are described in the literature. The aim of this study was to analyze all children with cross-unions who underwent surgery over the last 15 years. From 1998 to 2013, 8 children with a posttraumatic proximal cross-union of the forearm (Type 3 according to Vince and Miller) received surgical treatment with resection of the cross-union or radial head. Mean age at the time of initial trauma was 9.0±2.56 years (range 6-14 years), age at the time of surgery was 11.9±3.09 years (range 7-16 years). Mean time of resection of the crossunion was 23.2 months. Follow-up time was 10.6 months (range 1-36 months). Five patients had a resection of the cross-union without any interposition techniques, in 2 cases with an additional arthrolysis of the elbow. One patient had an interposition of a local fascia flap. In 2 cases, a primary excision of the radial head, six and seven years, respectively, after trauma, was performed. All patients, except one, had non-steroidal antiinflammatory drugs therapy after surgery. A post-operative irradiation was performed in 3 cases. The mean postoperative range of motion for pronation/supination was 36/0/53°. Controversy remains about the best procedure to adopt for posttraumatic cross-union in childhood. After analysis of our data and the literature, we recommend the resection of the crossunion within 6-24 months of occurrence without necessarily using any interposition techniques. All patients reported an improvement with regard to ordinary activities. In cases of long-term cross-union for several years with ankylosis of the elbow and bony deformities of the proximal radius, an excision of the radial head as salvage procedure is recommended.