Rotation Restored: Fascia Lata Interposition for Proximal Radioulnar Synostosis after Olecranon Plating

Introduction: A debilitating side effect of comminuted elbow or forearm fractures and their surgical treatment is proximal radioulnar synostosis (PRUS), which is defined by heterotopic bone bridging between the radius and ulna and nearly total loss of forearm rotation. The standard treatment for established PRUS is surgical removal of the synostotic mass; nevertheless, unless a long-lasting interposition barrier is employed, recurrence persists as a threat. Autologous tensor fascia lata (TFL) grafting has been shown to restore rotation with minimal donor-site morbidity and serves as a biologic interposition. Aim: Excision with TFL interposition for post-traumatic PRUS following proximal ulna plating: a comprehensive, critically updated review and original cohort experience with a focus on technique, functional results, recurrence, graft integration, heterotopic ossification (HO) prophylaxis, and rehabilitation plan. Materials and Methods: This retrospective observational study examined a consecutive cohort treated between 2017 and 2024, demonstrating radiologic graft integration, low donor-site morbidity, uncommon recurrence, significant improvement in pronation–supination and functional scores, and confirming – consistent with larger series – the effectiveness of TFL interposition when combined with complete extraperiosteal excision, circumferential graft fixation, early controlled mobilization, and targeted HO prophylaxis. Conclusion: Following proximal ulna fixation, excision combined with autologous TFL interposition is a dependable method of restoring rotation following PRUS. The establishment of standardized scheduling, graft selection, and preventive regimens requires multicenter prospective trials with prolonged follow-up. Keywords: Proximal radioulnar synostosis, tensor fascia lata graft, heterotopic ossification, autologous interposition.