Takedown of Post-traumatic Radioulnar Synostosis with Distal Radius Osteotomy, Distal Ulna Reconstruction Using Fresh-Frozen Allograft, and Distal Radioulnar Joint Stabilization in an Adolescent: A Case Report
Miguel Jaramillo, MD1, John J. Faillace, MD, FAAOS2*
1Ochsner Orthopedics & Sports Medicine Institute, Ochsner Health, New Orleans, LA, USA.
2Department of Orthopedic surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA.
*Corresponding Author: John J. Faillace, MD, FAAOS, University Blvd, Route 0165, Galveston, TX 77555-0165, United States.
https://doi.org/10.58624/SVOAOR.2026.06.026
Received: July 07, 2026
Published: September 22, 2026
Citation: Jaramillo M, Faillace JJ. Takedown of Post-traumatic Radioulnar Synostosis with Distal Radius Osteotomy, Distal Ulna Reconstruction Using Fresh Frozen Allograft, and Distal Radioulnar Joint Stabilization in an Adolescent: A Case Report. SVOA Orthopaedics 2026, 6:5, 196-201. doi: 10.58624/ SVOAOR.2026.06.026
Abstract
Post-traumatic distal radioulnar synostosis is a rare complication of forearm trauma that produces loss of pronation and supination and substantial functional impairment. It is uncommon in skeletally immature patients, in whom ongoing growth may compound deformity and bone loss. We report the case of a 13-year old girl who presented with complete loss of left forearm rotation, chronic discomfort, and paresthesia ten years after a high-energy both-bone forearm fracture sustained at age three that had been treated with casting alone and without follow-up. Imaging demonstrated osseous fusion of the distal radius and ulna with marked radial articular malposition and lateral subluxation of the radiocarpal joint. She underwent a reconstruction comprising synostosis resection, a corrective osteotomy of the radius, distal ulnar reconstruction with a fresh-frozen allograft to restore length to a shortened, hypoplastic ulna, and distal radioulnar joint stabilization using a palmaris longus tendon graft. Intraoperative examination confirmed restoration of forearm rotation. At two-year follow-up, the patient had 50 degrees of adequate forearm rotation, no pain, no functional limitation, and no radiographic evidence of recurrent synostosis, and she had returned to school athletics. This case illustrates that, beyond simple bony-bridge excision, correction of the associated skeletal deformity and joint instability may be required to restore function in long-standing pediatric post-traumatic synostosis.
Keywords: Radioulnar synostosis; Synostosis; Forearm Injuries; Bone Transplantation; Adolescent; Reconstructive Surgical Procedures