Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 9, pp 1195–1201

Single-stage treatment of complete dislocation of radial head and forearm deformity using distraction osteogenesis in paediatric patients having multiple cartilaginous exostosis

  • Bilal Demir
  • Sarper Gursu
  • Kahraman Ozturk
  • Timur Yildirim
  • Mehmet Nuri Konya
  • Turgay Er
Orthopaedic Surgery

Abstract

Background

We are reporting the results of single-stage treatment for patients with forearm deformity and radial head luxation due to hereditary multiple exostosis using distraction osteogenesis.

Method

Six patients with a mean age of 12 years were treated. Morphological evaluation was made according to Masada (3 of the cases were 2a and 3; 2b). Angular deformities of forearm and wrist were evaluated as described by Fogel (distal radial joint angle was 27°, ulnar variance was 12.8 mm and carpal slip was 71.3%). Mean forearm pronation was 48.4° whilst mean supination was 19.2°. Mean elbow range of motion was 26.6°–103.4° and the mean DASH score was 75. Common surgical procedures were deformity correction, ulnar lengthening and gradual radial head reduction using external fixators.

Results

Mean follow-up period was 4.2 years and mean external fixation time was 6 months. Mean amount of ulnar lengthening was 2.9 cm and the distraction index was 14.9 cm/day. Mean radial articular angle was 14.3°, ulnar variance 2.3 mm, carpal slip 55%, forearm pronation 65.9° and supination was 55°. Mean elbow range of motion was 15.8°–119.2°. In the last follow-up, the mean value of DASH score was 8.1. Major and minor complications were seen during the follow ups.

Conclusions

Single-stage deformity correction, ulnar lengthening and radial head reduction technique that we have used provide satisfactory functional and cosmetic results. Early surgical correction may lead to even better results.

Keywords

Multiple cartilaginous exostosis Radial head luxation Distraction osteogenesis 

References

  1. 1.
    Dahlin DC, Unni KK (1996) Bone tumors: general aspects and data on 11.087 cases, 5th edn. Lippincott-Raven, Philadelphia, pp 11–23Google Scholar
  2. 2.
    Peterson HA (1989) Multiple hereditary osteochondromata. Clin Orthop 239:222–230PubMedGoogle Scholar
  3. 3.
    Noonan KJ, Levenda A, Snead J et al (2002) Evaluation of the forearm in untreated adult subjects with multiple hereditary osteochondromatosis. J Bone Joint Surg Am 84:397–403PubMedGoogle Scholar
  4. 4.
    Matsuno T, Ichioka Y, Yagi T, Ishii S (1988) Spindle-cell sarcoma in patients who have osteochondromatosis. A report of two cases. J Bone Joint Surg 70-A:137–141Google Scholar
  5. 5.
    Schmale GA, Conrad EU, Raskind WH (1994) The natural history of hereditary multiple exostoses. J Bone Joint Surg 76-A:986–992Google Scholar
  6. 6.
    Wicklund CL, Pauli RM, Johnston D, Hecht JT (1995) Natural history study of hereditary multiple exostoses. Am J Med Genet 55:43–46PubMedCrossRefGoogle Scholar
  7. 7.
    Shapiro SA, Javid T, Putty T (1990) Osteochondroma with cervical cord compression in hereditary multiple exostsoses. Spine 15:600–602PubMedCrossRefGoogle Scholar
  8. 8.
    Wood VE, Sauser D, Mudge D (1985) The treatment of hereditary multiple exostosis of the upper extremity. J Hand Surg 10-A:505–513Google Scholar
  9. 9.
    Shapiro F, Simon S, Glimcher MJ (1979) Hereditary multiple exostoses. Anthropometric roentgenographic and clinical aspects. J. Bone Joint Surg 61-A:815–824Google Scholar
  10. 10.
    Wise CA, Clines GA, Massa H et al (1997) Identification and localization of the gene for EXTL, a third member of the multiple exostoses gene family. Genome Res 7:10–16PubMedCrossRefGoogle Scholar
  11. 11.
    Peterson HA (1994) Deformities and problems of the forearm in children with multiple hereditary osteochondromata. J Pediatr Orthop 14:92–100PubMedCrossRefGoogle Scholar
  12. 12.
    Mc Cornack EB (1981) The surgical management of hereditary multiple exostosis. Orthop Rev 10:57–63Google Scholar
  13. 13.
    Ogden JA (1976) Multiple hereditary osteochondromata. Report of an early case. Clin Orthop 116:48–60PubMedGoogle Scholar
  14. 14.
    Siffert RS, Levy RN (1965) Correction of wrist deformity in diaphyseal aclasis by stapling. Report of a case. J Bone Joint Surg Am 47:1378–1380PubMedGoogle Scholar
  15. 15.
    Burgess RC, Cates H (1993) Deformities of the forearm in patients who have multiple cartilaginous exostosis. J Bone Joint Surg 75-A:13–18Google Scholar
  16. 16.
    Stanton RP, Hansen MO (1996) Function of the upper extremities in hereditary multiple exostoses. J Bone Joint Surg Am 78:568–573PubMedGoogle Scholar
  17. 17.
    Solomon L (1963) Hereditary multiple exostosis. J Bone Joint Surg 45-B(2):292–304Google Scholar
  18. 18.
    Stanton RP, Hansen MO (1996) Function of the upper extremities in hereditary multiple exostoses. J Bone Joint Surg 78:568–573PubMedGoogle Scholar
  19. 19.
    Fogel GR, Mc Elfresh EC, Peterson HA, Wicklund PT (1984) Management of deformities of the forearm in multiple hereditary osteochondromas. J Bone Joint Surg Am 66:670–680PubMedGoogle Scholar
  20. 20.
    Rodgers WB, Waters PM, Hall JE (1996) Chronic Monteggia lesions in children. Complications and results of reconstruction. J Bone Joint Surg Am 78:1322–1329PubMedGoogle Scholar
  21. 21.
    Ring D, Waters PM (1996) Operative fixation of Monteggia fractures in children. J Bone Joint Surg Br 78:734–739PubMedGoogle Scholar
  22. 22.
    Pritchett JW (1986) Lengthening the ulna in patients with hereditary multiple exostoses. J Bone Joint Surg Br 68:56–57Google Scholar
  23. 23.
    Slongo TF (2008) Correction osteotomy of neglected “monteggia” lesion with an external fixator. Oper Orthop Traumatol 20(4–5):435–449PubMedCrossRefGoogle Scholar
  24. 24.
    Gordon JE, Schoenecker PL, Oda JE et al (2003) A comparison of monolateral and circular external fixation of unstable diaphyseal tibial fractures in children. J Pediatr Orthop B 12(5):338–345PubMedCrossRefGoogle Scholar
  25. 25.
    Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 250:81–104PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Bilal Demir
    • 1
  • Sarper Gursu
    • 2
  • Kahraman Ozturk
    • 2
  • Timur Yildirim
    • 2
  • Mehmet Nuri Konya
    • 2
  • Turgay Er
    • 2
  1. 1.Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research HospitalIstanbulTurkey
  2. 2.Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research HospitalIstanbulTurkey

Personalised recommendations