Rotational Osteotomy for Radioulnar Synostosis

Courtesy: Scott Kozin, Dan Zlotolow, Shirner’s hospital for Children, USA

Congenital synostosis of the forearm is generally well tolerated, as most children are born with their forearms stuck in a neutral position. For children with a moderate to severe forearm pronation or supination contracture, a rotational osteotomy can set forearm rotation to a more useful position. We recommend somewhere between 15 and 30 degrees of pronation. Compartment syndrome is a risk, particularly with correction of more severe deformities. We therefore recommend a slight shortening of the forearm to relieve some of the tension that arises from rotating the forearm, analogous to wringing a towel.