1. Mobilization of a Congenital Proximal Radioulnar Synostosis with Use of a Free Vascularized Fascio-Fat Graft*† by FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am Volume 80(8):1186-92 August 1, 1998 ©1998 by The Journal of Bone and Joint Surgery, Inc.

2. Figs. 1-A, 1-B, and 1-C: Schematic drawings showing the operative procedure. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

3. Fig. 1-B The radial head is reduced, and the distal fragment is supinated. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

4. Fig. 1-C A vascularized fascio-fat graft is inserted in a volar-to-dorsal direction between the separated radius and ulna. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

5. Figs. 2-A through 2-D: Photographs illustrating the intraoperative procedure. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

6. Fig. 2-B After separation of the synostosis and the synchondrosis, the radial head (arrow) is trimmed and a trapezoid-shaped wedge of bone is resected to reduce the dislocated radial head. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

7. Fig. 2-C The radius is fixed with a four-hole titanium plate. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

8. Fig. 2-D The vascularized fascio-fat graft is shown along with a segment of skin obtained from the ipsilateral arm. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

9. Figs. 3-A through 3-F: Case 7. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

10. Fig. 3-B Lateral roentgenogram showing the posterior dislocation of the radial head. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

11. Fig. 3-C Computerized tomographic scan showing the synostosis of the radius and ulna and a thin intervening septum. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

12. Figs. 3-D, 3-E, and 3-F: Roentgenograms and computerized tomographic scans made two years and six months postoperatively. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

13. Fig. 3-E Lateral roentgenogram showing reduction of the radial head. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.

14. Fig. 3-F Computerized tomographic scan showing separation of the synostosis. FUMINORI KANAYA, and KUNIO IBARAKI J Bone Joint Surg Am 1998;80:1186-92 ©1998 by The Journal of Bone and Joint Surgery, Inc.