An Evaluation of Forearm Deformities in Hereditary Multiple Exostoses: Factors Associated With Radial Head Dislocation and Comprehensive Classification

Jo, Ah Reum; Jung, Sung Taek; Kim, Myung Sun; Oh, Cheol Young; Min, Byung Ju

doi:10.1016/j.jhsa.2017.01.010

Cited by 33 publications

(29 citation statements)

References 25 publications

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“…Jo and S.T. Jung proved statistically in their work that the proportion of ulna shortening to the radius as well as forearm bone bowing (RB) were predictive factors of radial head dislocation [7]. We did not reveal statistical significance of the RB angle value even in the group of patients with radial head dislocation.…”

Section: Discussioncontrasting

confidence: 57%

“…Type IVB: osteocartilaginous exostoses located in the distal parts of both forearm bones without radial head dislocation (Fig. 2) [7]. However, these classifications do not fully disclose the entire variety of deformities of the forearm bones in children due to osteocartilaginous exostoses, but indicate only the location of exostoses and the position of the head of the radius.…”

Section: Original Articlementioning

confidence: 99%

“…Thus, a combination of radial head dislocation with multiplanar deformities of the forearm bones leads to limitation of rotation and loss of function of the upper extremities [7][8][9][10][11][12][13]. Peterson suggested that preventing the development of forearm bone deformities in patients with MHO, in particular radial head dislocation, is the most important goal of early surgical treatment [14].…”

Section: Original Articlementioning

confidence: 99%

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Clinical and radiological characteristics of forearm deformities in children with multiple hereditary exostoses

Zakharyan¹,

Белоусова²,

Pozdeev³

2019

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Introduction The incidence of forearm deformities in children with multiple hereditary exostoses (MHE) ranges from 30 to 80 %. There are few studies of deformities of the forearm in MHE patients in the literature that describe not only the location of exostoses and position of the head of the radius but also the true variants of forearm deformities. The aim of the study was to investigate forearm bone deformities in patients with multiple hereditary exostoses. Materials and methods Radiographs of the bones of the forearm in 84 patients (151 limbs) diagnosed with multiple hereditary exostoses in the age of four to 17 years who were treated at our institute from 2004 to 2018 were retrospectively analysed. The study involved 47 boys and 37 girls; 67 patients (80 %) had bilateral lesions, and 17 patients (20 %) had lesions of only one upper limb. Patients were divided into four groups depending on the type according to the Jo& Jung's classification. The deformities were evaluated based on radiological methods in accordance with the reference lines and angles for the forearm bones. Results The most common variants of forearm deformities were revealed: varus recurvatum at the border of the upper and middle third of the ulna (55 %), varus recurvatum at the border of the upper and middle third of the ulna associated with varus of the radius in the middle third (15 % of cases); as well as their combinations accompanied by dislocation or subluxation of the radial head (30 %). RAA (radial articular angle) and RB (radial bowing) did not have significant difference in various types of deformities of the forearm according to Jo&Jung's classification. Conclusion The study of the variety of forearm deformities in children due to multiple hereditary exostoses will assist in a differentiated approach to the choice of surgical treatment methods depending on the type of deformity.

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Section: Discussioncontrasting

confidence: 57%

Section: Original Articlementioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

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Clinical and radiological characteristics of forearm deformities in children with multiple hereditary exostoses

Zakharyan¹,

Белоусова²,

Pozdeev³

2019

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“…In that regard, retrospective natural history studies may refine the wide and crude indications of surgery currently used in children with HMO. Two natural history studies are praised for aiming to identify radiographic predictors of radial head dislocation [ 4 , 51 ]. Likewise, well-designed randomized control studies where one group receives a definite surgical treatment and the other receives no treatment should be rethought.…”

Section: Discussionmentioning

confidence: 99%

Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review

El-Sobky

Samir

Atiyya

et al. 2018

SICOT-J

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Introduction: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis?Methods: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence.Results: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/− associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others.Discussion: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures.

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“…Most forearm deformities in patients with HME are caused by ulna shortening [2,18,19] . The distal ulna is affected by exostoses, which lead to dysplasia and shortening.…”

Section: Discussionmentioning

confidence: 99%

Older age and multi-joint external fixator are two risk factors of complications in ulnar lengthening in children with hereditary multiple exostosis

Zheng

Han

Cao

2020

Preprint

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Objectives: Hereditary multiple exostosis (HME) often involves forearm deformities. The aim of this study was to present the clinical results of 37 children who underwent ulnar lengthening with two different types of unilateral external fixators, and to investigate the risk factors of complications. Methods: We evaluated 37 children with forearm deformities caused by HME treated in our hospital from January 2008 to July 2019. The surgical procedures included resection of exostosis, osteotomy of the ulna, and gradual lengthening of the ulna with a single arm external fixator. According to the type of external fixator they received, the children were divided into two groups: group A received monorail fixators, and group B received multi-joint fixators. Radiographic and functional parameters were assessed. Complications were recorded. Results: All patients were followed up for an average of 4.6 years (3.0 to 6.5). In both group A and group B, the ulna shortening (US), radial articular angle (RAA), carpal slip (CS), elbow flexion, forearm pronation, supination, and Mayo Elbow Performance Score (MEPS) values improved significantly from preoperatively to postoperatively ( p < 0.05). However, ulnar deviation was observed in 4 cases in group B and no cases in group A. According to logistic regression, the difference was only related to age ( p <0.05) and the type of external fixator ( p <0.05). Conclusions: Ulnar lengthening with unilateral external fixation is a safe and effective procedure for the treatment of HME. Regarding complications, deviation of the ulna axis was more likely to occur in older children with multi-joint external fixators.

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An Evaluation of Forearm Deformities in Hereditary Multiple Exostoses: Factors Associated With Radial Head Dislocation and Comprehensive Classification

Cited by 33 publications

References 25 publications

Clinical and radiological characteristics of forearm deformities in children with multiple hereditary exostoses

Clinical and radiological characteristics of forearm deformities in children with multiple hereditary exostoses

Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review

Older age and multi-joint external fixator are two risk factors of complications in ulnar lengthening in children with hereditary multiple exostosis

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