Forearm deformities in hereditary multiple exostosis: clinical and functional results at maturity.

BACKGROUND

Thirty to 60% of hereditary multiple exostoses patients have forearm deformities. There is no consensus regarding optimal therapy. This long-term retrospective study is the first to compare radiologic and clinical data with patient assessments, to define more precise surgical indications.

METHODS

All children presenting with hereditary multiple exostose during the period from 1990 to 2010 were retrospectively analyzed. Masada forearm deformity classification, treatment, clinical course, and radiologic data were included from the preoperative period to the last follow-up. Operated mature patients self-assessed their functional handicap using the QuickDASH score.

RESULTS

Eighteen children (27 forearms) were included. Thirteen of the children had forearm operations, one twice, on the average at 11.1 ± 3 years of age. The average age at last follow-up was 17.6 ± 3.7 years. Data analysis showed no significant functional and radiologic improvement between the early postoperative period and last follow-up. Average QuickDASH score was 15.3 ± 14.9 (out of 100), indicating minor self-assessed handicap despite major clinical and radiologic abnormalities.

CONCLUSIONS

Symptomatic radial head instability appears to be an indication for ulnar lengthening surgery. Even severe deformity without dislocation may be managed conservatively given the lack of postoperative functional improvement. Corrective radial osteotomy may be considered near the end of the growth spurt.

LEVEL OF EVIDENCE: Level IV.