Surgical treatment of the congenital radioulnar synostosis in children: systematic review

Background. Congenital radioulnar synostosis (CRUS) may have a negative impact on the function of the upper limb and cause disability. The main aim of the surgical treatment is to correct the forearm position for diminishing functional limitations. The study aimed to analyze surgical methods for correction of the pronation forearm deformity in children with CRUS. Material and methods. We analysed the age at surgery, indications for surgery, the target functional forearm position, the time of consolidation of the forearm bones, the frequency of neurovascular complications. Results. Most authors considered subjective complaints as the main indication for surgical treatment. The median age at surgery was 5.17 years (3.25-9.46). The medians of the recommended forearm positions for unilateral CRUS were 0-10 of pronation for the dominant, and 0-12.5 of supination for the non-dominant limb; with bilateral cases 0-17.5 pronation for the dominant and 0-12 supination for the non-dominant limb. Median of the osteotomy consolidation time varied from 6 to 8 weeks. The maximal time of forearm bone consolidation was significantly higher (p=0.024) in the group with osteotomies through the synostosis . Though the target forearm position was achieved in all cases, the number of complications in the proximal osteotomy group was statistically significantly different (p0.01) - the chances of neurovascular complications were 20.5 times higher (95% CI: 2.7-155.6). Conclusion. The problem of surgical treatment of children with CRUS remains relevant. Development of an algorithm regarding the need for surgical treatment and type of surgery requires further research.