Reconstruction of forearm deformities in multiple cartilaginous exostoses

Ip, David; Li, Yun H.; Chow, Wang; Leong, J. C. Y.

doi:10.1097/00009957-200301000-00003

Cited by 9 publications

(14 citation statements)

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“…In our group of patients we decided to intervene before they reached skeletal maturity; the ideal time for surgery, however, remains an open debate. In fact, several authors suggested early intervention, due to greater potential for remodeling, which in turn would lead to better surgical results; however, recurrence of ulnar shortening was noted following the lengthening procedure [ 10 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, if the course of the disease is long, adaptive pathological changes such as radial head deformation or a bow-shaped deformity caused by radial overgrowth may occur secondary to chronic joint dislocation [ 9 ]. Biomechanical studies have shown that ulnar shortening occurs because the distal physis contributes to the total length of the radius more than the distal radial physis does [ 10 – 12 ]. Moreover, the distal ulnar physis has a smaller cross-sectional area than the radial one, causing a greater proportional involvement of the ulnar growth plate; differential longitudinal growth on the radial and ulnar border results in an increase in the distal radial articular angle, and ultimately in radial head dislocation [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Gradual ulnar lengthening in children with multiple exostoses and radial head dislocation: Results at skeletal maturity

D’Ambrosi¹,

Barbato²,

Caldarini³

et al. 2016

Journal of Children's Orthopaedics

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PurposeDeformities of the forearm and shortening of the ulna occur in 30 % of patients with hereditary multiple exostoses (HME), leading to radial head dislocation and loss of movement. Several surgical techniques have been described for treatment, and the aim of our study was to present clinical and radiographic results at skeletal maturity in 15 children that underwent the surgical procedure of ulnar lengthening with external fixators.MethodsWe evaluated 15 patients with ulnar shortening and radial head dislocation that underwent external fixation procedures. Radiographic assessment included measurement of radial articular angle, carpal slip, and ulnar shortening. Clinical evaluation included range of motion, MAYO Elbow Score, assessment function of the extremity as described by Stanton, the visual analog scale (VAS) for pain, and SF-12 to evaluate quality of life.ResultsThe average follow-up period was 77 months and took place when each patient had reached skeletal maturity. MAYO Elbow Score improved from 34.7 to 93.3 points, while the average preoperative functional assessment criteria score was 1.6 points and improved to 4.4. The preoperative average VAS ranged from 8.2 to 2.3, while the SF-12 in its physical (PCS) and mental (MCS) components resulted, respectively, as 53.3 and 54.2. Pronation and supination improved from a preoperative average value of 35.6° and 51.3° to 70° and 80.6°, respectively, at the most recent follow-up visit. Flexion and extension ranged, respectively, from 143° and 2° to 146.7° and 3°. Ulnar shortening improved from 24 mm preoperative to 3 mm, and radial articular angle varied from 37.7° preoperative to 26° at the last follow-up. Only one complication occurred in our group, and one patient completely healed from a case of nonunion of the ulna.ConclusionsUlnar lengthening is a safe and reliable procedure for the treatment of HME that provides good to excellent results and reduces radial head dislocation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gradual ulnar lengthening in children with multiple exostoses and radial head dislocation: Results at skeletal maturity

D’Ambrosi¹,

Barbato²,

Caldarini³

et al. 2016

Journal of Children's Orthopaedics

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“…Various techniques for the surgical treatment of forearm deformities in patients with multiple cartilaginous exostoses have been reported, but the method of operative treatment still remains controversial (Akita et al, 2007;Fogel et al, 1984;Ip et al, 2003;Masada et al, 1989;Matsubara et al, 2006;Noonan et al, 2002;Pritchett, 1986;Shin et al, 2006;Wood et al, 1985). Shin et al (2006) reported that the simple excision of exostoses did not improve the radiographic parameters, but led to a significant increase in supination of the forearm.…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the individual situation, acute or fixator-controlled gradual ulnar lengthening is often combined with excision of exostoses and simultaneous radial correction procedures, such as hemiepiphysiodesis and osteotomies (Fogel et al, 1984;Ip et al, 2003;Masada et al, 1989;Vogt et al, 2011;Wood et al, 1985). But there is no universal consensus regarding the most appropriate operative intervention (Akita et al, 2007;Matsubara et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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

Song¹,

Lee²,

Youssef³

et al. 2012

J Hand Surg Eur Vol

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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.

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“…Some recommend early intervention, which has more potential for remodeling and leads to better surgical results 5,8,13,14. Masada, et al5 noted recurrence of ulnar shortening after lengthening in 13 forearms.…”

Section: Discussionmentioning

confidence: 99%

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

Cho

Jung

2014

Yonsei Med J

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PurposeMultiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems.Materials and MethodsWe retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator.ResultsGood clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up.ConclusionTreatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.

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Reconstruction of forearm deformities in multiple cartilaginous exostoses

Cited by 9 publications

References 0 publications

Gradual ulnar lengthening in children with multiple exostoses and radial head dislocation: Results at skeletal maturity

Gradual ulnar lengthening in children with multiple exostoses and radial head dislocation: Results at skeletal maturity

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

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

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