Proximal radioulnar arthrolysis to improve the rotation of the forearm

Objective To discuss the proximal radioulnar arthrolysis for the treatment of rotatory dysfunction of the forearm after elbow injury. Methods From January to December 2007,we treated 12 patients with limited rotation of the forearm following elbow injury. They were 9 males and 3 females (3 left elbows and 9 right elbows),averaging 37.7 (27 to 48) years. Their primary injuries included terrible triad (3),proximal ulnar fracture (4),radial head fracture (4) and coronoid fracture (1). Before open arthrolysis,11 patients had had operation. The average time from injury to open arthrolysis was 9 (6 to 27) months. The average rotation of the forearm before arthrolysis was 56.7°(0 to 130°). We treated 7 patients through posterior approach,3 through combined bilateral approaches and 2 through lateral approach. Scar tissue,osteophyte and ectopic ossification around the proximal radioulnar joint were resected,but the radial head was retained if possible. Possible measures were tried to maintain pronation at 80° and supination at 90° during operation. The patients began active and passive exercises the first day after operation. Indomethacin was administered the first day after open arthrolysis as a routine. Results All patients were followed up for 14 to 25 (average,18.3) months. The patients got an average of 157.5° (130° to 170°) of rotation of the forearm. No elbow instability or dislocation of the proximal radioulnar joint was found. Conclusion Careful open arthrolysis of the proximal radioulnar joint and early rehabilitative exercise can lead to good results for rotatory dysfunction of the forearm after elbow injury. Key words: Elbow joints;  Wounds and injuries;  Recovery of function;  Surgical procedures