Corrective derotation osteotomies to treat congenital radioulnar synostosis in children: results of a systematic review and meta-analysis

Background The primary objective of this review is to estimate the rotational correction after corrective derotation osteotomies (CDO) for congenital radioulnar synostosis (CRUS). The secondary objective of this review is to identify the complications with CDO in CRUS. Methods We included studies in the English literature from electronic bibliographic databases Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Directory of Open access journals (DOAJ), EMBASE, MEDLINE, ProQuest, PubMed, and Scopus up to December 2020 that determined the effects of CDO in CRUS for two or more cases with a mean follow-up of 1 year or more. We used the National Institutes of health quality assessment tool for case series (interventional) and Modified Coleman methodology Score for assessment of risk of bias in the included studies. Results We pooled 383 forearms (318 participants) from 23 studies with mean age of 6.28 ± 1.75 years. The mean pronation deformity was 72.83 ± 15.64° from 22 studies. The CDO derotated forearm to 10.4 ± 5.90° of mean pronation in 12 studies and 13.47 ± 9.51° of mean supination in nine studies. One study corrected the forearms to a neutral position. The mean derotation from CDO was 73.13 ± 16.54° (35° supination to 130° pronation). The overall mean difference was − 68.26° [95% CI − 86.87, − 49.66] of correction favoring supination. There were eight transient nerve palsies and six compartment syndromes from synostosis site osteotomies (four studies). Discussion We had poor-quality studies at a high risk of bias on the described tools of assessment. We could estimate the directional effect of CDO in CRUS favoring correction from pronation to supination; however, due to the heterogeneity among studies, we cannot comment on the most efficient and least harmful CDO techniques. The single bone osteotomies seem to be efficient, simple, and reportedly low on complications but need evaluation. We cannot define the indications for correction and expected improvement in functional outcomes from osteotomy techniques.