Long-Term Results of Surgery for Forearm Deformities in Patients with Multiple Cartilaginous Exostosis

Author(s): Akita S, Murase T, Yonenobu K, Shimada K, Masada K, Yoshikawa H

Source: Journal Bone and Joint Surg 89-A (9):  1993-1999, 2007.

Summary:

This study is a retrospective review from Japan of twenty-three patients with thirty-one forearms that underwent surgical treatment for multiple cartilaginous exostosis.  The mean age at the initial procedure was eleven years and the mean duration of follow up was thirteen years.  All patients underwent excision of exostoses.  Seventeen patients underwent a corrective osteotomy and/or lengthening of the radius and ulna.  Two forearms had an attempt at open reduction of a dislocated radial head and two radial head excisions were performed in the skeletally mature patients.  At final follow up, only four patients had mild pain and only five patients had mild restrictions of daily activities.  Eight patients stated the appearance of the forearm was unsatisfactory.  Overall range of motion was not significantly improved compared to preoperative range except for significant improvement in forearm pronation from 43 to 65 degrees at final follow up.  Osteotomies and lengthenings resulted in unsustained improvement in radiographic parameters, but at final follow up there is no change in these parameters.  Eighteen ulnar lengthenings were performed in sixteen forearms.  Eight were performed gradually with a distraction external fixator and ten were performed acutely.  Complications included nonunion of three forearms, fracture of callus at the site of  lengthening in two forearms and temporary radial nerve paralysis in one forearm.  Five dislocated radial heads were identified in this series.  Two underwent an attempt at open reduction but there was failure in maintaining reduction and both developed evidence of degenerative changes with restriction of motion at the time of most recent follow up.  The two patients underwent radial head excision at skeletal maturity ultimately had no pain and significant improvement in range of motion.

The authors conclude that the most beneficial procedure for patients with forearm deformities related to multiple cartilaginous exostosis was that of simple excision of exostoses which generally resulted in significant improvement in forearm pronation.  Considering that corrective and lengthening osteotomies did not ultimately improve radiographic parameters and there was a significant complication rate of upwards of 28% associated with ulnar lengthening osteotomy, the authors recommend caution when considering corrective procedures.

 

Related Links