Tumor Location Affects the Results of Simple Excision for Multiple Osteochondromas in the Forearm

Author(s): Ishikawa JI, Kato H, Fujioka F, Iwasaki N, Suenaga N, Minami, A

Source: The Journal of Bone & Joint Surgery 89-A (6): 1238-1247, 2007.

Summary:

A retrospective review is provided of 14 forearms in 13 children with a follow-up of more than 24 months (average, 53 months).  Group 1 (six forearms) was characterized by the osteochondroma only in the distal aspect of the ulna which caused compression of the radius and bowing.  Group 2 (eight forearms) had osteochondromas in both the distal aspect of the ulna and the ulnar side of the distal part of the radius which contacted with each other.  Generally Group 1 pre-operatively were found to have greater ulnar shortening and radial bowing than Group 2.  Post-operatively in Group 1, ulnar shortening improved from 8 % to 7% whereas no change was noted in Group 2.  The radial bow improved in Group 1 from 10% to 7 % with deterioration in Group 2 from 7 % to 8%.  Radial articular angle did not change in Group 1, but deteriorated in Group 2 from 35 degrees to 43 degrees.  Carpal slip angle slightly improved in both groups and recurrence was noted in two of six patients in Group 1 and five of eight patients in Group 2.

The effectiveness of simple excision of osteochondromas of the distal aspect of the forearm is influenced by the tumor location and is related to the pattern of the deformity.  Simple tumor excision can correct the forearm deformity in patients with an isolated osteochondroma of the distal part of the ulna.  However, patients with tumors involving the distal part of the ulna and ulnar aspect of the distal end of the radius have less correction of deformity following tumor excision.  There was a high rate of recurrence in five of eight forearms in Group 2 making it difficult to state firm conclusions on the effectiveness of simple tumor excision in this group.  Therefore, the authors recommend ulnar lengthening in Group 2 patients to release the tethering and support the ulnar carpus when the radial articular angle and carpal slip are severe.

Osteochondroma, Excision, Forearm, Rotation, Radius, Ulna


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