Bilateral Congenital Radioulnar Synostosis in a 21-Month Old Male

Case Report

J Fam Med. 2016; 3(6): 1074.

Bilateral Congenital Radioulnar Synostosis in a 21-Month Old Male

Tawfik SF* and Anderson S

Physician Assistant Program, College of Healthcare Sciences, Nova Southeastern University, USA

*Corresponding author: Sylvia Tawfik, Physician Assistant Program, College of Healthcare Sciences, Nova Southeastern University, USA

Received: June 24, 2016; Accepted: August 11, 2016; Published: August 16, 2016


Congenital radioulnar synostosis is a malformation that can limit the ability to perform daily activities. The condition involves the fusion of the proximal aspect of the ulna and radial head. The condition may result as a congenital defect or posttraumatic complication. Depending on the severity of the anomaly, treatment options include surgical intervention or conservative therapy. This case report discusses the initial presentation of congenital radioulnar synostosis in a 21-month old male. Imaging supports incomplete synostosis of the left forearm and the early stages in the right forearm.

Keywords: Congenital malformation; Radioulnar synostosis; Derotational osteotomy

Case Presentation

A 21-month old Asian male was referred to an orthopedic surgeon by his pediatrician for left arm pain. His parents noticed certain limitations in movements of the left arm about three weeks ago, specifically in tasks requiring supination such as eating finger foods. The father stated that when trying to gently assist in these movements, the patient would cry. The pediatrician referred the toddler after a limited range of motion exam and abnormal radiographic imaging. The family stated that they have been regularly taking the infant for checkups and no abnormalities were noted in the past. The parents denied any trauma to the left arm.

Review of systems was negative for: fevers, abnormal weight change, changes in appetite, changes in sleep patterns, changes in behavior, excessive fussiness, vomiting, diarrhea, other joint pains or signs of inflammation. There was no known family history of bone deformity or skeletal disease. Birth history included spontaneous vaginal delivery at 39 weeks with no complications. No significant past medical history was given. Surgical history was positive for circumcision. The toddler lived with both of his parents and did not attend daycare. There was no history of smoking or drinking in the household.

The toddler’s vitals were unremarkable. He appeared well nourished with a height and weight appropriate for his age group. On exam, the toddler was resting comfortablyon his father’s lap and appeared in no acute distress. He was awake, alert, and oriented. Skin exam was normal with no erythema, edema, or ecchymosis. There was no tenderness to palpation of the left or right elbow including the lateral epicondyle, forearm, and wrist. Passive range of motion of the left arm showed flexion and extension from 20 to 140 degrees, 80 degrees of pronation, and 0 degrees of supination. The right arm showedflexion and extension from 0 to 140 degrees, 50 degrees of pronation, and 30 degrees of supination. Musculoskeletal range of motion exam was completed without pain or crepitus. Bilateral motor exam was unremarkable with sensation to light touch in medial, radial, ulnar, and axillary nerve distributions. Active range of motion and strength could not be tested due to the age of the toddler.

Heart was regular rate and rhythm with no murmurs, rubs, or gallops. Lungs were clear to auscultation bilaterally with no rhonchi or wheezing. No clubbing or cyanosis with a capillary refill less than 2 seconds. Radiographic imaging was ordered in the office of the forearm bilaterally. The left forearm showed a proximal fusion of the radius and the ulna (Figure 1). The right forearm showed early stages of synostosis in the same area as the left (Figure 2).