Rotational osteotomy of the radioulnar fusion

The ulnar fusion of the ulnar and ulna is used for the surgical treatment of congenital ulnar and ulnar fusion. Congenital ulnar and ulnar fusion is a rare congenital malformation. The etiology is mainly caused by the longitudinal segmental developmental disorder of the cartilage of the ulnar cartilage derived from the same mesoderm tissue during embryonic development. Often involved in the proximal end of the ulna, involving both sides more than one side, the incidence of men and women is roughly equal. This malformation can be divided into two types. Type I is a osseointegration, the most common, which is the proximal humerus fusion. The medullary cavity is connected between the two bones. The humerus is longer and thicker than the ulna, and the humerus is curved forward. Type II is a combination of cartilage or fibrosis, which is extremely rare. Sick children often see a doctor because of forearm rotation dysfunction. The diagnosis should be distinguished from the bone bridge formed between the ulnar and radial bones after trauma. The forearm rotation dysfunction can be found after birth and there is no history of trauma. The degree of dysfunction of the forearm varies with the position of the forearm. Most patients have their forearms fixed in the neutral position, mild pronation or mild supination. The compensation of the wrist and shoulder joints has little effect on the function. Need surgery. A small number of patients have their forearms fixed in a severe pronated position, which is difficult to wash, face tea cups, end rice bowls, and holding tableware. Surgical treatment should be considered. Treatment of diseases: congenital ulnar and ulnar fusion Indication The ulnar ulnar fusion is suitable for congenital ulnar and ulnar fusion. Forearm pronation is more than 60° dysfunction. Surgery is best done in childhood. Contraindications The forearm is fixed at the median or mild pronation (spin-off) position, and the function is not affected. Preoperative preparation Take a thorough examination of the whole body and take a positive X-ray of the forearm. Surgical procedure Incision From the ulnar olecranon, a long 8 cm incision was made to the distal side along the posterior edge of the ulna. 2. Reveal the ulna and iliac fusion The deep fascia was dissected to reveal the posterior margin of the ulna. The posterior aspect of the ulna had a posterior elbow muscle, the distal end had a ulnar wrist muscle, and the anterior side was a ulnar flexor carpi muscle. After the periosteum was cut along the posterior edge of the ulna, the fusion of the ulna and the tibia was removed along the periosteum to the outside of the tibia, and the fusion of the ulnar and ulna was fully revealed. 3. Rotary osteotomy and internal fixation A longitudinal line was used as a marker on the ulnar side of the ulna, and an osteotomy was performed at a distance of 1 cm proximal to the bifurcation of the ulna. It can be sawed with a wire saw, or a row of bone holes can be drilled on the osteotomy line with a hand drill, and then an osteotome can be used along the bone hole; or an air saw or a chainsaw can be used. Be careful to protect the surrounding tissue. After the osteotomy is completed, the distal side is longitudinally pulled, the forearm is rotated to the most suitable functional position, and the osteotomy ends are fixed by two Kirschner wires. Relax the tourniquet and observe the circulation of the affected limb. If the circulation is affected, the angle of rotation of the forearm should be reduced. 4. suture the wound Rinse the wound, completely stop bleeding, layered suture. complication Nerve injury When the ulnar and ulnar fusion is revealed and the osteotomy is performed, if the subperiosteal operation principle is not followed, the dorsal nerve of the bone can be damaged; the ulnar nerve and the median nerve are respectively passed between the ulnar flexor muscles and the pronated round muscles. If the severe deformity is corrected by rotating the osteotomy, the above two nerves may be compressed to cause nerve damage. If the pre-release release, extension or rotation correction angle is not excessive, it can be prevented. 2. Forearm ischemic contracture Severe malformation of rotational osteotomy can affect the blood supply of the affected limb and cause forearm ischemic contracture. Before the suture is sutured, the tourniquet should be routinely relaxed to observe the circulation. If there is a circulatory disorder, the corrected rotation angle should be reduced.