[Ortho] Врожденный синостоз лучевой и локтевой кости

[Trypolski]

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Methods 

Taking down the synostosis and interposition of soft tissue 
-poor results 
-narrowing of interosseous membrane 
-loss of correction with refusion 

Kelikian/Doumanian swivel 
-resection of a piece of proximal radius and insertion of swivel. 
-simultaneous transfer of FCR, FCU or EDU for active supination 
-failure secondary to loosening of swivel, swivel failure 

Derotational osteotomy distal to synostosis site 
-rotation of forearm to improved position distal to osteotomy 
-fixation was with K-wires, Steinman pins or staples 
-failure from loss of rotation secondary to tight interosseous membrane 
-significant risk of vascular compromise secondary to functional shortening of arteries of forearm
-the further the osteotomy from the synostosis the greater the vascular risk 

Derotational osteotomy through the synostosis mass 
-osteotomy through the synostosis with rotation to more functional position 
-position held with pins, external fixator or plaster until synostosis reforms 
-usual loss of 15 degrees of original correction 
-Simmons et al. in 1983, Kahalil and Vizkelety in 1993 demonstrated good functional out comes 
-bilateral cases should have one hand in slight pronation and the other in neutral position 

Derotational osteotomy with the Ilizarov Method 
-osteotomy through the synostosis 
-fixation proximally with hybrid fixation 
-fixation distally with half pins 
Ilizarov device with rotation/translation hinges 
-rotation at a rate of 4 degrees per day 
-low risk of vascular injury because of slow rotational correction
Trypolski