Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive loss of forearm rotation following a previous traumatic injury to the proximal/middle third of the forearm. Reports mechanical block during attempted pronation/supination, significantly impacting activities of daily living. No acute neurovascular deficit noted.
Clinical Examination Findings
Physical examination reveals fixed forearm in [Pronation/Supination/Neutral] position. Palpation demonstrates a palpable bony bridge at the site of previous fracture. Passive rotation is restricted by a hard end-feel. Neurovascular status: Radial/Ulnar pulses intact, capillary refill <2s, sensation intact in median, ulnar, and radial nerve distributions.
Treatment Protocol
Recommended management includes surgical excision of the synostosis, interposition of soft tissue/fat graft to prevent recurrence, and potential hardware removal if indicated. Post-operative protocol involves early mobilization, physical therapy, and consideration of prophylactic low-dose radiation or NSAIDs to mitigate heterotopic ossification.