Abstract
PURPOSE: Congenital radioulnar synostosis is a congenital disorder affecting the elbow. We aimed to investigate the baseline characteristics and the clinical and functional outcome of a cohort of children with congenital radioulnar synostosis undergoing operative and non-operative treatment. METHODS: This multicenter retrospective study evaluated children with congenital radioulnar synostosis admitted to three European pediatric orthopedic centers from January 1998 to April 2021. Baseline characteristics were extracted from medical records. Operative cases treated with rotational osteotomy were further analyzed. Outcomes were assessed using the Mayo Elbow Performance Score and the Quick-DASH questionnaire. RESULTS: Ninety-seven patients (122 forearms) were included. Forearm positions were predominantly neutral or excessively pronated. Type 3 Congenital radioulnar synostosis was the most common radiographic finding. A total of 52 patients (66 forearms) underwent proximal derotational osteotomy, achieving a neutral forearm position in 61.9% of cases. Six complications were reported. The mean follow-up was 4.5 ± 3.4 years. MEPS averaged 90.6 points and Quick-DASH 18.5 points. No significant differences were found between operated and non-operated cases. MEPS results were good or excellent in 77.9% of patients, while only 31% reported a Quick-DASH ≤ 7points. CONCLUSION: We present the largest case series of pediatric congenital radioulnar synostosis to date. Mild deformities caused minimal disability and required no surgery. For severe malrotation, proximal derotational osteotomy was safe, with low complication rates, restoring a neutral forearm position and yielding outcomes comparable to non-surgical management of mild cases.