Ulnar Lengthening for Negative Ulnar Variance in Hereditary Multiple Osteochondromas

1992 ◽  
Vol 1 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Roshen N. Irani ◽  
Robert C. Petrucelli
Keyword(s):  
Ulnar Variance ◽  
Multiple Osteochondromas ◽  
Ulnar Lengthening

scholarly journals Modified Osteotomy for Treatment of Forearm Deformities (Masada IIb) in Hereditary Multiple Osteochondromas: A Retrospective Review

2021 ◽  
Author(s):  
Ge Yan ◽  
Guoxin Nan
Keyword(s):  
Distraction Osteogenesis ◽  
External Fixator ◽  
Wrist Joint ◽  
Elbow Flexion ◽  
Wrist Flexion ◽  
Ilizarov External Fixator ◽  
Multiple Osteochondromas ◽  
Before And After ◽  
Ulnar Lengthening ◽  
Flexion And Extension

Abstract Purpose: Approximately 30% of patients with hereditary multiple osteochondromas (HMO) have forearm deformity and dysfunction. The aim of this retrospective study was to review our experience with the surgical treatment of children with HMO and Masada IIb forearm deformities.Methods: Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method.Results: Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction.Conclusion: Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna.

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

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 10 ◽  
Author(s):  
Tamer A. EL-Sobky ◽  
Shady Samir ◽  
Ahmed Naeem Atiyya ◽  
Shady Mahmoud ◽  
Ahmad S. Aly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Patient Characteristics ◽  
Control Group ◽  
Publication Date ◽  
Disease Characteristics ◽  
Multiple Osteochondromas ◽  
Paediatric Orthopaedic ◽  
Ulnar Lengthening

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.

The Shape of the Triangular Fibrocartilage During Pronation–Supination

2003 ◽  
Vol 28 (6) ◽  
pp. 537-545 ◽  
Author(s):  
A. MAKITA ◽  
T. NAKAMURA ◽  
S. TAKAYAMA ◽  
Y. TOYAMA
Keyword(s):  
Ulnar Variance ◽  
Forearm Rotation ◽  
Triangular Fibrocartilage ◽  
Significant Change ◽  
Ulnar Lengthening

We studied the changes in the shape of the triangular fibrocatilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3 mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation–supination, even with positive ulnar variance.

Clinical and Functional Outcomes of Ulnar Lengthening in the Treatment of Masada Type I Forearm Deformities in Hereditary Multiple Osteochondromas

2020 ◽  
Vol 45 (9) ◽  
pp. 876.e1-876.e7
Author(s):  
Soroush Baghdadi ◽  
Hamid Arabi ◽  
Amirreza Farhoud ◽  
Alireza Moharrami ◽  
Taghi Baghdadi
Keyword(s):  
Functional Outcomes ◽  
Type I ◽  
Multiple Osteochondromas ◽  
Ulnar Lengthening

Kienb�ck's disease with negative ulnar variance: surgical treatment with ulnar lengthening

2003 ◽  
Vol 4 (1) ◽  
pp. 30-34
Author(s):  
C. Chillemi ◽  
M. Marinelli ◽  
P. Raffaelli ◽  
A. Gigante
Keyword(s):  
Surgical Treatment ◽  
Ulnar Variance ◽  
Ulnar Lengthening

scholarly journals Modified osteotomy for treatment of forearm deformities (Masada IIb) in hereditary multiple osteochondromas: a retrospective review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ge Yan ◽  
Guoxin Nan
Keyword(s):  
Distraction Osteogenesis ◽  
External Fixator ◽  
Wrist Joint ◽  
Elbow Flexion ◽  
Wrist Flexion ◽  
Ilizarov External Fixator ◽  
Multiple Osteochondromas ◽  
Before And After ◽  
Ulnar Lengthening ◽  
Flexion And Extension

Abstract Purpose Approximately 30% of patients with hereditary multiple osteochondromas (HMO) have forearm deformity and dysfunction. The aim of this retrospective study was to review our experience with the surgical treatment of children with HMO and Masada IIb forearm deformities. Methods Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method. Results Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction. Conclusion Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna.

scholarly journals Gradual ulnar lengthening in Masada type I/IIb deformity in patients with hereditary multiple osteochondromas: a retrospective study with a mean follow-up of 4.2 years

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuchan Li ◽  
Zhigang Wang ◽  
Mu Chen ◽  
Haoqi Cai
Keyword(s):  
Retrospective Study ◽  
Radial Head ◽  
Elbow Flexion ◽  
Type I ◽  
Multiple Osteochondromas ◽  
External Frame ◽  
The Mean ◽  
Carrying Angle ◽  
Ulnar Lengthening

Abstract Background Gradual ulnar lengthening is the most commonly used procedure in the treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children. This study aims to evaluate the clinical and radiological outcomes of ulnar gradual lengthening in our clinic. Methods We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, 2 months after external frame removal, and at the last follow-up. Results The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at the index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37 ± 8 to 30 ± 7° initially (p = 0.005) and relapsed to 34 ± 8° at the last follow-up (p = 0.255). There was a minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). At the last follow-up, the mean forearm pronation and elbow flexion increased significantly (p < 0.001 and p = 0.013, respectively), and the mean carrying angle also improved significantly (p < 0.001). No patient with type IIb deformity achieved a concentric radial head reduction. Conclusions Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function in patients with Masada type I/IIb deformity. Our results supported early ulnar lengthening for patients with a tendency of dislocation of the radial head.

scholarly journals Management of Masada type I/IIb forearm deformity by gradual ulnar lengthening in patients with hereditary multiple osteochondromas

2020 ◽  
Author(s):  
Yuchan Li ◽  
Zhigang Wang ◽  
Mu Chen ◽  
Haoqi Cai
Keyword(s):  
Treatment Protocol ◽  
Elbow Flexion ◽  
Individual Treatment ◽  
Type I ◽  
Daily Life Activities ◽  
Multiple Osteochondromas ◽  
The Mean ◽  
Carrying Angle ◽  
Ulnar Lengthening

Abstract Background Gradual ulnar lengthening is the most commonly used procedure in treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children and only slightly handicapped of daily life activities in untreated adult patients. The aim of this study was to evaluate mid-term clinical and radiological outcomes of ulnar gradual lengthening in our clinic. Methods We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. Patients with less than two years of follow-up were excluded. The surgical procedures consisted of ulnar lengthening by external fixator and/or excision of the osteochondroma at the distal ulna. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, two months after external frame removal, and at the last follow-up. Results The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37.3 ± 7.9° to 29.8 ± 6.5° initially (P = 0.003) and relapsed to 34.4 ± 7.6° at the last follow-up (p = 0.234). There was minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). The elbow flexion and forearm pronation were improved significantly at last follow-up (p < 0.001 and p = 0.024, respectively). The mean carrying angle improved significantly from − 6.3 ± 7.4 ° preoperatively to 7.4 ± 11.1° at last follow-up (p < 0.001). Conclusions Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function; it is recommended for patients with Masada type I/IIb deformity. Therefore, we advocated aggressive individual treatment protocol for patients with Masada type I/IIb deformities.

scholarly journals Excision of Distal Ulnar Exostosis: A Case Series and Literature Review

2018 ◽  
Vol 25 (1) ◽  
pp. 49-53
Author(s):  
Leung Cheuk Yip ◽  
Alexander K.Y. Choi ◽  
Chan Ping Tak ◽  
Chow Yuk Yin
Keyword(s):  
Skeletal Maturity ◽  
Case Series ◽  
Ulnar Variance ◽  
Type I ◽  
Forearm Rotation ◽  
Aggressive Approach ◽  
Simple Excision ◽  
Ulnar Lengthening

Background Multiple Hereditary Exostoses with distal ulnar exostosis often results in forearm deformity and functional restrictions. Literature reported variable outcomes and frequent complications with an aggressive approach of ulna lengthening. The role of distal ulnar exostosis excision remained uncertain with contradictory effect in restoring growth. Our study aimed to report our outcome of simple excision and compare with the reported results in literature. Method Retrospective review was carried out in patients with distal ulnar exostoses excision who were operated from 2003 to 2011. Patients with less than 3 years of follow-up, radial head dislocation or subluxation, or within 3 years of skeletal maturity were excluded. Clinical outcome including range of forearm rotation was documented. Radiological outcomes including radial articular angle, carpal slip, ulnar variance and radial bowing were measured. The results were analysed statistically and compared with literature. Results Five cases were included in our study. All had excision of exostosis, and one case had additional ulnar lengthening. Mean age of operation was 10.4 years. Mean follow-up time was 72 months. Improvement was shown in the range of pronation, radial articular angle, carpal slip and ulnar variance, in the cases with simple excision alone. Improvements were mostly achieved at the first postoperative year. However, for the case with concomitant lengthening, ulna shortened relatively with growth, and complications were reported. This phenomenon is in keeping with the literature finding. Conclusion Simple excision of distal ulnar exostosis improves forearm rotation and provides some restoration of growth in skeletally immature patients with Masada type I deformity.

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