title: Outcomes of anconeus interposition for proximal radioulnar synostosis.
abstract: OBJECTIVE
  Proximal radioulnar synostosis after elbow injuries can produce debilitating contractures. The estimated range of motion required to perform many activities of daily living is a 100° arc of forearm rotation. We hypothesized that excision of heterotopic bone and anconeus flap interposition could restore functional prono-supination in patients with proximal radioulnar synostosis.
  
  
  METHODS
  Patients with proximal radioulnar synostosis were subdivided into 2 groups on the basis of etiology: (1) as a complication after distal biceps tendon repair or (2) as a result of direct trauma to the proximal forearm/elbow. All patients underwent an excision of the synostosis with interposition of an anconeus flap and were observed clinically for a minimum of 6 months.
  
  
  RESULTS
  Twenty-three patients (16 men, 7 women) were included, with a mean age of 47 years and mean clinical follow-up of 4.8 years. Mean arc of forearm rotation improved from 21° to 132°, pronation increased from 12° to 70°, and supination increased from 9° to 62° (P < .0001). Patients with biceps tendon repair etiology (n = 7) displayed greater gains in pronation and a trend toward greater total forearm rotation than did those with a traumatic etiology (n = 16).
  
  
  CONCLUSIONS
  Anconeus interposition flap for management of proximal radioulnar synostosis produces significant and reliable clinical improvement in elbow prono-supination. Patients with biceps tendon repair etiology had a trend toward greater motion improvement than that of patients with a traumatic etiology. The degree of improvement seen would provide nearly full restoration of functional motion, resulting in minimal limitations in activities of daily living.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. Electronic address: daluiskia@hss.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Daluiski
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Schreiber
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hotchkiss
mesh_terms: D000328:Adult; D000368:Aged; D001134:Arm Injuries / Q000150:complications; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000601:surgery; D011884:Radius / Q000002:abnormalities* / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013524:Surgical Flaps; D013580:Synostosis / Q000209:etiology / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery; D016896:Treatment Outcome; D014457:Ulna / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Proximal radioulnar synostosis; anconeus interposition; elbow trauma