Single staged rotational osteotomy for congenital radioulnar synostosis: a case report

Abstract

Congenital radioulnar synostosis is a rare congenital anomaly characterized by a failure of segmentation between the proximal radius and ulna during embryonic development, leading to restricted forearm rotation. The condition is often bilateral and may be associated with syndromic disorders. Management varies depending on severity, ranging from observation and physiotherapy to surgical correction. A six-year-old boy presented with bilateral limitation of forearm rotation interfering with daily activities. The right forearm was fixed in 60° pronation and the left in 20° pronation. Radiographs confirmed osseous fusion between the proximal radius and ulna without radial head dislocation, consistent with Cleary and Omer type II congenital radioulnar synostosis. A single-stage rotational osteotomy of the radius and ulna was performed on the right side under general anesthesia. The osteotomies were created distal to the synostosis, and the forearm was rotated to achieve 20-30° of supination without internal fixation. The limb was immobilized in an above-elbow cast for five weeks. Postoperative recovery was uneventful, and at four months, the patient demonstrated union at the osteotomy sites with significant improvement in functional activities such as feeding and self-care. Surgical correction is indicated in cases with significant functional limitation. Performing the osteotomy distal to the synostosis reduces the risk of neurovascular injury. The single-stage rotational osteotomy provided satisfactory correction and improved forearm function without complications. This case highlights the effectiveness and safety of distal single-stage rotational osteotomy in managing congenital radioulnar synostosis in children.