Modified Ilizarov technique for the treatment of forearm deformities in multiple cartilaginous exostoses: case series and literature review

Abstract

The aim of this study is to evaluate the results of gradual ulnar correction and lengthening using the modified Ilizarov technique for the treatment of forearm deformities in patients with multiple cartilaginous exostoses. We retrospectively reviewed 23 forearms in 16 patients. Three different types of operative procedures were performed: (1) corrective osteotomy and gradual lengthening of the ulna, (2) corrective osteotomy of the radius, and (3) excision of exostoses. We evaluated the radiographs; range of motion of the wrist, forearm, and elbow; and functional status using a questionnaire before and after operation. During the clinical interview, post-operative functional status was significantly improved than pre-operative functional status, 12 patients stated that they had no difficulty in performing daily activities, 11 patients stated that they had no pain, and 11 patients stated that the post-operative appearance of the operated forearm was satisfactory. At time of final follow-up, the mean range of motion of the wrist in ulnar/radial deviation, forearm pronation/supination was significantly improved. Also, the radiographic parameters including radial articular angle, carpal slip, radial bowing, and ulnar variance were significantly improved at time of final follow-up. In conclusion, we achieved successful clinical and radiological outcomes in our patients with forearm deformities after treatment with the modified Ilizarov method. However, there could be a recurrence of ulnar shortening and deformity during growth periods in skeletally immature patients.

Gradual ulnar lengthening in Masada type I/IIb deformity in patients with hereditary multiple osteochondromas: a retrospective study with a mean follow-up of 4.2 years

“…However, the necessity of operation for such deformities is still controversial, and appropriate treatment is challenging, especially for children. The core of these problems is the concern of recurrence after surgery in skeletally immature patients [ 2 , 10 , 11 ] and less restriction of daily life activities in adult patients. Stanton and Hansen [ 12 ] and Arms et al [ 13 ] suggested less aggressive corrective surgery for forearm deformities because skeletally mature patients have a good tolerance to minimal functional impairment and appearance deformity.…”

Management of Masada type I/IIb forearm deformity by gradual ulnar lengthening in patients with hereditary multiple osteochondromas

“…However, the necessity of operation for such deformities is still controversial, and appropriate treatment is challenging, especially for children. The core of these problems is the concern of recurrence after surgery in skeletally immature patients [2,10,15], and less restriction of daily life activities in adult patients children [8,9]. Noonan et al found that only 13% of untreated adult patients, often with varying degrees of functional de cit, had substantial pain or limitations related to their job performance [16], and patients were found adaptable and with excellent Quick DASH questionnaire responses in previous study [10].…”

Multiple osteochondromas (MO) in the forearm: a 12-year single-centre experience

“…An expectant approach is carried out for Masada type II problems if symptoms are mild and the radial head is stable. If advanced functional impairment as well as instability and pain is present, we either plan a 2-stage procedure (first levelling of the forearm bones and, later, a radial head resection—rarely) or we advocate a complex correction with indirect reduction of the radial head using a ring fixator [ 20 , 21 ]. In patients with type III deformity, we offer to remove the painful osteochondroma but counsel most patients to wait until growth is completed.…”