Radioulnar Synostosis Derotation Osteotomy

Radioulnar Synostosis Derotation Osteotomy

Peter M. Waters

Operative Indications

  • Complete radioulnar congenital synostosis (Figure 13.1)

  • Pronation contracture >60° to >90°, especially if bilateral (Figure 13.2)

  • Functional limitations in activities of daily living

Alternative Treatments

  • Natural history adaptations

    • Adaptable shoulder internal rotation to supinate by back-handing (Figure 13.3)

    • Palm to ceiling to hold objects

    • Compensatory increased rotation through radiocarpal joint (Figure 13.4)

  • Surgical synostosis excision

    • Synostosis takedown and interposition arthroplasty (silastic, fat, aconeus, vascularized fascia)

    • High rate of recurrent synostosis

    • Even with successful takedown, without recurrence, true forearm rotation only mildly improved


  • Supine with operative arm on radiolucent table

Surgical Approach

  • Use lateral fluoroscopy to identify the synostosis, proximal and distal extent of radioulnar synostosis (RUS), ulnotrochlear joint

    • Mark skin to aid percutaneous technique

  • Use fluoroscopy to identify medullary canal ulna

    • Choose wire diameter that will fill 50%-75% of the ulna medullary canal

  • Identify entry site olecranon apophysis (Figure 13.6)

  • Medullary canal usually thinner than expected

    • Choose smaller diameter smooth wire to fit full-length ulna