Image-based quantitative osteotomy planning for congenital proximal radioulnar synostosis: plan–execution discrepancy and postoperative radiographic outcomes
Journal
Journal of Shoulder and Elbow Surgery
ISSN
1058-2746
Date Issued
2026-06
Author(s)
Abstract
Background: Proximal radioulnar synostosis is a rare congenital anomaly that restricts forearm rotation and significantly impairs daily function. Surgical correction typically involves radial osteotomy with shortening and derotation; however, planning of osteotomy level, bone shortening, and rotational correction remains largely subjective and relies heavily on surgeon experience. This study retrospectively evaluated an image-based quantitative planning framework designed to provide objective geometric parameters for osteotomy in congenital proximal radioulnar synostosis. Methods: Preoperative anteroposterior and lateral radiographs from 8 unilateral cases were reconstructed to derive patient-specific deformity geometry, central bone axes, cut points, predicted cutting angles, and model-estimated radial shortening. The planning algorithm uses polynomial fitting and calculus-based minimization to identify osteotomy points. These predictions were compared with intraoperative measurements and postoperative radiographic and functional outcomes. Results: All procedures were complication-free, and 7 of 8 forearms showed improved rotational range. At final follow-up, 2 forearms had concentric radial head alignment, whereas 6 showed mild subluxation or dislocation. Observationally, larger discrepancies between model-estimated and surgeon-applied shortening were associated with suboptimal postoperative radial head alignment. In one representative case, a substantial discrepancy corresponded with progressive radial head dislocation despite preserved clinical motion. Conclusion: This study highlights the potential value of quantitative, image-based modeling to support osteotomy planning by providing transparent, reproducible parameters that may reduce variability in surgical decision-making. Although limited by its small sample size, retrospective design, and reliance on radiographs, this work establishes a foundation for future prospective validation of computational decision-support tools in pediatric orthopedic deformity correction.
Subjects
Case Series
computational modeling
forearm rotation
image-based modeling
Level IV
osteotomy
pediatric orthopedics
Proximal radioulnar synostosis
radiographic outcomes
surgical planning
Treatment Study
Publisher
Elsevier BV
Type
journal article