Pfanner S, Bigazzi P, Casini C, De Angelis C, Ceruso M
Hand Surgery and Reconstructive Microsurgery Unit, AOU Careggi, 50139 Florence, Italy.
Case Rep Orthop. 2016;2016:5956304. doi: 10.1155/2016/5956304. Epub 2016 Feb 8.
Radioulnar synostosis is a rare complication of forearm fractures. The formation of a bony bridge induces functional disability due to limitation of the pronosupination. Although the etiology of posttraumatic synostosis is unknown, it seems that the incidence is higher in patients who have suffered a concomitant neurological or burn trauma, and extensive soft tissue injury, mainly due to high-energy impact. Surgical treatment, such as reinsertion of distal biceps tendon into the radius, seems to be another possible factor. The aim of the surgical treatment is to remove the bony bridge and restore complete range of movement (ROM), thus preventing recurrence. Literature does not indicate a preferred type of surgical procedure for the aforementioned complication; however, it has been shown that surgical interposition of inert material reduces the formation rate of recurrent bony bridge. We describe a surgical technique in two cases in which the radius and ulna were wrapped with allogenic, cadaver fascia lata graft to prevent bony bridge formation. The data from 2 years of follow-up are reported, indicating full restoration of ROM and no recurrence of synostosis.
桡尺骨融合是前臂骨折的一种罕见并发症。骨桥的形成会因旋前旋后受限而导致功能残疾。尽管创伤后融合的病因尚不清楚，但似乎在伴有神经或烧伤创伤以及广泛软组织损伤（主要由于高能冲击）的患者中发病率更高。手术治疗，如将肱二头肌远端肌腱重新插入桡骨，似乎是另一个可能的因素。手术治疗的目的是去除骨桥并恢复完整的活动范围（ROM），从而防止复发。文献中并未指出针对上述并发症的首选手术方式；然而，已表明惰性材料的手术植入可降低复发性骨桥的形成率。我们描述了一种手术技术，在两例手术中用同种异体尸体阔筋膜包裹桡骨和尺骨以防止骨桥形成。报告了2年随访的数据，显示ROM完全恢复且融合未复发。
