The Journal of Bone and Joint Surgery, Vol 67, Issue 4 539-545, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Congenital proximal radio-ulnar synostosis. Natural history and functional assessment
JE Cleary and GE Omer
We evaluated the cases of twenty-three patients with thirty-six congenital
proximal radio-ulnar synostoses who had been followed between 1938 and
1984. None of the patients had had any attempt at surgical correction or
any ipsilateral congenital anomalies. Emphasis was placed on analyzing the
natural history of the lesion in these patients who had not been operated
on, and on determining the effect of a fixed position of the forearm on
function. Ten patients had unilateral and thirteen, bilateral synostosis.
Their mean age when last examined was twenty-two years (range, three to
fifty years). Eight patients were female and fifteen, male. The forearms
were fixed in an average of 30 degrees of pronation. The position of the
forearm was not found to be related to subjective functional limitations,
employment status, or the results of the hand-function test of Jebsen et
al. Most patients had few or no functional limitations, and were employed
in jobs that demanded extensive use of the forearm. Contrary to the
findings of other studies, we observed four distinct radiographic patterns
based on the presence of an osseous synostosis and the position of the
radial head. However, we noted no relationship between any of these
patterns and function. We concluded that operative treatment of congenital
radio-ulnar synostosis is rarely indicated, that less emphasis should be
placed on the single factor of the position of the forearm, and that
objective functional tests should be included in the assessment of these
patients.
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