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Distraction osteogenesis at the proximal third of the ulna for the treatment of Masada type I/IIb deformities in children with hereditary multiple exostoses: a retrospective review of twenty cases

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A Letter to the Editor to this article was published on 27 February 2023

Abstract

Background

Ulna distraction by monolateral external fixator (MEFix) is a good option for the treatment of Masada type I and IIb deformities in children with hereditary multiple exostoses (HMEs). However, there is no consensus regarding where to perform ulnar osteotomy. Our hypothesis is that osteotomy at the proximal third of the ulna and progressive distraction with MEFix can simultaneously correct elbow and wrist deformities in patients with HME.

Methods

We retrospectively reviewed patients with HME who underwent ulna distraction osteogenesis from June 2014 to March 2019. The carrying angle (CA), radial articular angle (RAA), ulnar variance (UV), radial variance (RV) and range of motion (ROM) of the affected forearm and elbow were clinically assessed before lengthening and at the last follow-up visit. The total ulna lengthening distance (LD) and radiographic outcome were also recorded.

Results

Nineteen patients (20 forearms) with HME aged 9.1 ± 2.4 years at the time of surgery were retrospectively reviewed. The mean follow-up period was 26.1 ± 5.6 months. There were 11 patients (12 forearms) with Masada type I deformities and eight patients (8 forearms) with Masada type IIb deformities. Patients with type IIb deformity had higher RV, lower CA values, less elbow flexion and forearm pronosupination than those with type I deformity (p < 0.05); RV was an independent risk factor for radial head dislocation, with the cut off at RV > 15.5 mm. The mean LDs in patients with type I and type IIb deformities were 33.6 ± 6.6 mm and 41.4 ± 5.4 mm, respectively. The mean CA, UV, RV, forearm pronation and ulna deviation at the wrist improved significantly following surgery in all patients. In particular, five of eight patients (62.5%) with type IIb deformities had concentric reduction of the radiocapitellar joint, while no radial head subluxation was detected in patients with type I deformities at the last follow-up. Three complications were recorded: two pin-track infections and one delayed union.

Conclusions

Distraction osteogenesis at the proximal third of the ulna provides satisfactory clinical and radiological outcomes in patients with Masada type I and IIb deformities. Early treatment of Masada type I deformities is indicated before progression to more complex type IIb deformities.

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Funding

The authors received financial support from Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014).

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Authors and Affiliations

  1. Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China

    Yunan Lu, Ran Lin, Yuling Huang, Xinwu Wu, Binbin Lin & Shunyou Chen

  2. Department of Paediatric Orthopaedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France

    Federico Canavese

  3. Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014), Fuzhou, 350007, China

    Shunyou Chen

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  1. Yunan Lu
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  4. Yuling Huang
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Contributions

Yunan Lu: design of the study, manuscript preparation, statistical analysis, revision. Binbin Lin and Ran Lin drafted the manuscript, statistical analysis.

Yuling Huang and Xinwu Wu: statistical analysis and revision of the manuscript.

Federico Canavese: design of the study, manuscript preparation, statistical analysis, revision.

Shunyou Chen: design of the study, surgery and general supervision of the research group.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shunyou Chen.

Ethics declarations

All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This was a retrospective study, and IRB approval was obtained (approval No. 2022068).

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The authors declare no competing interests.

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Lu, Y., Canavese, F., Lin, R. et al. Distraction osteogenesis at the proximal third of the ulna for the treatment of Masada type I/IIb deformities in children with hereditary multiple exostoses: a retrospective review of twenty cases. International Orthopaedics (SICOT) 46, 2877–2885 (2022). https://doi.org/10.1007/s00264-022-05551-6

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