Ulnar Lengthening/Reconstruction of Interosseous Membrane in Treatment of OsteochondromaFunding None.
26 February 2017
07 August 2017
07 September 2017 (eFirst)
Background We aim to measure the quality of life and clinical and functional outcomes of a patient who had undergone ligament reconstruction of the forearm interosseous membrane, using brachioradialis tendon more ulna distraction osteogenesis in treatment with multiple cartilaginous exostosis.
Case Description We present a 11-year-old boy with congenital deformity in his right, dominant forearm,Type IIb by Masada classification. Distraction of the ulna, resection of exostosis, and reconstruction of the distal part of the interosseous membrane was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 60 degrees and supination was 90 degrees. Elbow flexion was 120 degrees, extension was −5 degrees, and digit motion was full. DASH score of 5, VAS of 0, and grip strength of 92% compared to the unaffected side were obtained. Forearm radiographic aspects showed healing of the distraction, articular congruency, the distal radioulnar joint (DRUJ), and radiocapitellum joint. The distraction distance was 28 mm, the distraction period was 67 days, the consolidation period was 96 days, and the period of fixator treatment was 92 days. The distraction speed was 0.5 mm/day. Good stability and joint congruency of the DRUJ and elbow were obtained. Good radiographic, clinical, and functional results were obtained improving the life quality of that patient.
Literature Review The treatment of forearm deformities is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the timing of the intervention have been a matter of controversy in the literature. Would DRUJ be stable when ulnar lengthening is combined with excision of exostosis? Is it possible to reduce the radial head with this technique?
Clinical Relevance We would like to suggest an interosseous membrane (distal oblique band) reconstruction to improve this treatment. We believe this suggestion could maintain DRUJ and elbow more stable and functional. We agree that the best time to perform the corrections is early and gradually. We prefer to correct the ulna, radius, DRUJ and elbow in many steps than in only one procedure.
Keywordsmultiple osteochondromas - forearm deformity - relative ulnar shortening - wrist deformity - interosseous membrane reconstruction
The research presented here was approved by and was in accordance with the ethical standards of the Faculdade de Medicina do ABC Ethics Committee on human experimentation by no. 1750176. An informed consent document was provided to the patient, who read and signed it according to his will.
- 1 Matsubara H, Tsuchiya H, Sakurakichi K, Yamashiro T, Watanabe K, Tomita K. Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses. J Orthop Sci 2006; 11 (05) 459-466
- 2 Ham J, Flipsen M, Koolen M, van der Zwan A, Mader K. Multiple osteochondromas (MO) in the forearm: a 12-year single-centre experience. Strateg Trauma Limb Reconstr 2016; 11 (03) 169-175
- 3 Masada K, Tsuyuguchi Y, Kawai H, Kawabata H, Noguchi K, Ono K. Operations for forearm deformity caused by multiple osteochondromas. J Bone Joint Surg Br 1989; 71 (01) 24-29
- 4 Bilen FE, Eralp L, Balci HI, Kocaoglu M, Ozger H. Correction of forearm deformities in children with multiple osteochondroma, by corrective radial osteotomy and ulnar lengthening by distraction osteogenesis. Acta Orthop Belg 2009; 75 (06) 743-747
- 5 Aita MA, Mallozi RC, Ozaki W, Ikeuti DH, Consoni DAP, Rugiero GM. Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the DRUJ. Rev Bras Ortop 2017; DOI: 10.1016/j.rbo.2016.12.002.