Multiple osteochondromas (MO) in the forearm: a 12-year single-centre experience

Abstract

Multiple osteochondromas (MO) are a rare autosomal dominant disorder characterized by the presence of osteochondromas located on the long bones and axial skeleton. Patients present with growth disturbances and angular deformities of the long bones as well as limited motion of affected joints. Forearm involvement is found in a considerable number of patients and may vary from the presence of a simple osteochondroma to severe forearm deformities and radial head dislocation. Patients encounter a variety of problems and symptoms e.g., pain, functional impairment, loss of strength and cosmetic concerns. Several surgical procedures are offered from excision of symptomatic osteochondromas to challenging reconstructions of forearm deformities. We describe visualizing, planning and treating these forearm deformities in MO and, in particular, a detailed account of the surgical correction of Masada type I and Masada type II MO forearm deformities.

Korrekturosteotomie des distalen Humerus und Unterarms – eine praktische Übersicht

“…In complex forearm corrections, and here in chronic Monteggia pathology patients, an individualized treatment plan depending onthe deformity, the age ofthe patient, and the status of the radial head and the PRU joint can either lead to a near anatomic reconstruction with good functional result or, in cases of longstanding deformity and established arthrosis, salvage procedures with good pain reduc-tion and functional improvement. Here the complication rate (in the authors' consecutive series) is >10%, comprising nerve injury (under 2%), residual deformity (around 6%), pin-site related infection (3%), reoperation for postoperative ulnar plus deformity, hardware removal, and soft tissue revision [1,3,12,13,21]. All complex corrections, e.g., fixator-based techniques, are prone Fig.…”

“…Posttraumatic elbow and forearm deformity can occur after either non-operative or operative treatment of acute fractures, as well as following deformity correction surgery (iatrogenic); it presents as impairment of function that is often exacerbated during growth [1]. While the most common deformity at the elbow, varus deformity, was seen for many years as a "purely" cosmetic problem, recent publications and the observation in the authors' multidisciplinary group from Hamburg, Düsseldorf, and Markgröningen, Germany, have shown that longstanding varus deformity of the elbow can lead to ulnar neuritis, medial instability, and functional impairment of the affected upper extremity [3][4][5][6][7]. Nonunion of the radial or ulnar condyle leads to severe arthrosis of the affected elbow joint, resulting in pain, loss of motion, and handicap in daily life and professional activities [8].…”

“…Fig. 2; [2,3,9]). It may also occur due to abnormal joint kinematics following radioulnar joint malalignment secondary to axial malunion.…”

“…In all corrective cases, a structured treatment plan is formulated and discussed preoperatively according to Paley's principals in complex corrections, namely, diagnosis, clinical features, problems, obstacles, and equipment required [1]. Additional measurements at the distal forearm and wrist, such as carpal slip, radial bow, radial articular angle, among others, are performed where necessary; these are described in detail elsewhere [3].…”

“…Chronic radial head dislocation is mainly of posttraumatic origin and caused by overlooking a Monteggia fracture dislocation in childhood (therefore termed "missed Monteggia" or "chronic Monteggia lesion"). A second etiology in the authors' international consultancy between The Netherlands and Germany is a progressive forearm deformity with resulting chronic radial head dislocation in the case of the Masada IIB subtype of the rare hereditary disease multiple osteochondromata [3]. Hereditary radial head dislocation(often bilateral) and cases of overlooked chronic pediatric "pulled-elbow" are extremely rare.…”