Emma Hughes, BS
Medical Student
Southern Illinois University School of Medicine
Springfield, Illinois, United States
Parker Brush, MD
Orthopedic Surgery Resident
Southern Illinois University School of Medicine
Springfield, Illinois, United States
This patient is a 5 year old African-American male who presented to the pediatric orthopedics clinic with bilateral elbow stiffness and left arm pain after a fall. At birth the patient had fully contracted arms with elbow flexion to 160o, treated with bracing. This resulted in limited elbow flexion of 60-70o at 12 months. Observation was the chosen treatment at that time.
Physical exam revealed swelling at the left elbow without tenderness. There was inability to extend either elbow and pain with passive movement on the left.
Initial radiographs at 12 months demonstrated abnormal proximal ulna to medial distal humerus relationships with sclerosis and potential ankylosis bilaterally. New radiographs revealed progression of fusion changes involving the distal humerus and proximal ulna with no evidence of fracture. The patient was placed in a long arm commercial splint, and follow-up was scheduled.
Discussions:
Only 5 cases of humeroulnar synostosis have been documented, more frequently in a syndromic setting3, as in this case (Pfeiffer syndrome). One other case has been described with Pfeiffer syndrome4. This is the first case of bilateral humeroulnar synostosis in the literature.
Most ADLs require from 30o-130o of flexion and 50o promotion to 50o supination5. Previous treatments for this condition have included surgical resection and intensive therapy with positive outcome3. There is very little data regarding interventions/outcomes for patients with humeroulnar synostosis due to its remarkable rarity. Other types of elbow ankylosis have been treated successfully with surgical resection.
Conclusions: A 5 year old male was seen with bilateral humeroulnar synostosis, a new finding in the literature. Treated with bracing and observation, with the possibility of future surgical intervention. Daily activity has not been significantly impacted, but continued innovative therapy and assistive technology will be required to adapt and adjust to his functional limitations as he grows.
