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

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.