Lengthening the ulna in patients with hereditary multiple exostoses

Abstract

Deformity of the forearm is common in patients with hereditary multiple exostoses, producing cosmetic and functional impairment in which shortening of the ulna is a significant factor. The results of ulnar lengthening in 10 forearms of eight patients are reported. Lengthening was performed by osteotomy of the shaft followed immediately by a bone graft and internal fixation, or by gradual distraction with an external fixator. In all patients the appearance was improved and the range of radial deviation at the wrist was increased. In most patients forearm movement and radial head stability were improved. Partial recurrence of the deformity was seen during the follow-up of skeletally immature patients, but in general ulnar lengthening was found to be a useful operation.

Time-lapse technic used to uncover the naturel growth of osteochondromas of the wrist in patients with Hereditary Multiple Osteochondromas

“…However, the marked shortening is considered important in the planning of treatment for forearm deformities. [12][13][14][15][22][23][24][25][26] Some advocate early aggressive management to prevent deformity and disability [14,17,[21][22][23][26][27][28][29][30][31] and others are more conservative and have reported satisfactory function in skeletal mature patients without surgical intervention. [4,16] The natural history of wrist deformity in HMO remains unknown and the role and timing of surgical treatment therefore controversial.…”

Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses

“…Futhermore, a dislocation of the radial head can be reduced using gradual lengthening with an external fixator. 1 Therefore we believe that our method is a good way to treat forearm deformity due to osteochondroma.…”

“…Some cases undergo malignant transformation and become secondary chondrosarcomas. 1 Although various treatment alternatives have been proposed to deal with such deformities and shortening of the forearm, lengthening of the ulna with correction only or with lengthening of the radius is considered to be the most appropriate treatment. However, most reports show only short term results and little is known about the postoperative course.…”

“…10 Prichett reported that lengthening of the ulna and correction of the radius, particularly with the use of an external fixator, has given predictable results and is a useful method of treating forearm deformity in patients with hereditary multiple exostoses. 1 It appears that we reached the consensus of a need for lengthening and normalization of the relationship of the radius and ulna, but controversy in the literature now exists regarding whether forearm lengthening is best achieved immediately or gradually. Some authors have reported that immediate lengthening of the ulna should be limited to 20 mm because greater lengthening can cause neurovascular problems.…”

“…Some recommend early intervention, because earlier intervention has more potential for remodeling and leads to better surgical results. 1,8,9,16,17 Others recommend intervention at a later age, because a recurrent operation can be avoided by postponing the procedure and good function can be acquired despite significant deformity after skeletal maturity. 14,18 We perform the operation if the patients have the indication without considering their age.…”