الفهرس 
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Abstract
Congenital radioulnar synostosis is a rare problem and is thought to be a failure of longitudinal segmentation between the radius and ulna at the 7th week of gestation. Because it is due to a defect in utero, it may be associated with some musculoskeletal anomalies and congenital syndromes such as polydactyly, syndactyly and thumb deformity(1).
Congenital radioulnar synostosis was first described by Sandifort in 1793. Congenital radioulnar synostosis is one of numerous components of malformation syndromes in children with chromosomal aberration .It is believed that this malfor¬mation is related to chromosome X aberrations. Some cases of congenital radioul¬nar synostosis was found in chromosome Y aberrations (2).
Deformity occurs equally in both males and females and bilateral involvement occurs in 60% to 80% of patients. In addition, family history has also been positive in some cases. Because of the fusion of the proximal radioulnar joint, patients always presented with a fixed degree of pronation, and the degree of pronation determine the degree of the disability and age of presentation ,the more the degree of deformity the more degree of disability and the more early age of presentation (1).
Congenital radio-ulnar synostosis is the most frequent congenital anomaly around the elbow joint. Some disabilities in daily activities occurs such as failure to scoop up water in the hands, to use a table knife, fork or chopsticks, or to drink water from a glass. In older children, the main complaint is often difficulty in sport (3).
Movements at the elbow-joint are usually free, although, extension is often not quite maximal. Movements at the wrist joint are often free, due to a laxity of the capsular ligaments. The affected forearm appears thinner and is sometimes shorter than the sound one in unilateral cases. It has a curious twisted appearance, due to an alteration in the axis of the principal groups of muscles, and on the postero-lateral aspect in its upper part there is a well-marked sulcus corresponding to the normal position of the head of the radius(4).
The forearm complex functions to rotate the hand in space and allow for a redistribution of forces during functional tasks. These functional tasks are dependent upon the coordinated movement and interactions between the proximal radioulnar joint (PRUJ), interosseous membrane (IOM), and the distal radioulnar joint (DRUJ). Disruptions of any one of these regions can potentially lead to limitations in forearm rotation and function.(5)
Children presented for evaluation when they had functional deficit. The presence of bilateral synostosis leads to an earlier presentation. Diagnosis depend on clinical examination and Radiological findings in plain Xray, computed tomography (C.T.)and Magnetic resonance imaging (MRI) (6)
Lines of treatment of congenital radioulnar synostosis varies according to degree of disability in cases of mild limitation can be managed conservative with follow up in severe disability different lines of surgical management can be done including excision of synostosis mass ,single osteotomy distal to synostosis mass , double osteotomy distal to synostosis and osteotomy with interposition of vascularized faciofat graft (5