Heterotopic ossification about the elbow joint can lead to considerable
functional disability, including the loss of forearm rotation. Many
procedures have been described for the treatment of proximal radioulnar
synostosis. Varying degrees of success have been achieved with regard
to the improvement of the flexion arc, but less success has been
reported in terms of the restoration of forearm rotation. The success
of treatment is associated with the extent of heterotopic ossification, soft-tissue
scarring, and anatomical distortion. A new and simple technique
to address the unresectable proximal radioulnar synostosis is described.
Seven patients were managed with a partial proximal radial resection
distal to the synostosis and were followed for an average of eighty
months (range, twenty-four to 144 months).
Forearm rotation improved from an average fixed pronation of 5°
to an average arc of 98° (range, 40° to 175°).
The average functional score improved from 57 points preoperatively
to 81 points at the time of the final review. Complications included
reankylosis at the site of the resection and ulnar-nerve sensory
neurapraxia in one patient each.
Resection of a 1-cm-thick section of the proximal part of the radial
shaft provides a safe and reliable method of improving forearm rotation
in patients with heterotopic ossification of the elbow. A single
technical factor that seems to positively influence the result is
the application of bone wax at the resection site. This simple procedure
is ideally suited for patients who have a proximal radioulnar synostosis
that (1) is too extensive to allow a safe and discrete resection,
(2) involves the articular surface, and (3) is associated with an