Ilizarov reconstruction on forearm deformity due to multiple hereditary exostoses
Keywords:
Ilizarov reconstruction, forearm deformity, multiple hereditary exostoses, outcomeAbstract
Introduction:
Multiple hereditary exostoses (MHE) is a rare medical condition that usually located at the most rapidly growing ends of long bones and manifested by multiple lesions and frequently associated with characteristic skeletal deformities. Management of this disease has many problems. Therefore, it is a challenge for orthopaedic surgeons for such cases are rarely found and the complexity they may have. We did an Ilizarov reconstruction for deformity correction while maintaining the length of the forearm with good outcome and no complications.
Methods:
We present a series of 3 patients with forearm deformiy due to MHE. They were between 5-17 years old. All of them showed a marked ulnar shortening, radial bowing, and radial head dislocation or subluxation. We performed corrections using Ilizarov frame to gradually lengthen the ulna until the most distal part achieved a range of -2 mm from radial styloid for normal ulnar variance. Subsequently, the distal radius ulna was temporary transfixed with K wire and the ulnar lengthening continued along with gradual traction of the radius until the radial head achieved the level of articulation with the humoral capitellum. Open reduction was needed, followed by temporary pin fixation of the radial head to the humoral capitellum. Osteotomy of the radius was performed in patient 3 (with severe bowing deformity) to straighten the radius.
Results:
With Ilizarov method, forearm deformities were corrected, ulnar deviation was improved, prominence of the radial head on the lateral elbow was diminished, and gradual reduction of the radial head on humeral capitellum was safely completed, therefore, this method optimally maintained the length of the forearm. All three patients had no complications, especially no radial nerve injury, and no significant pin track infection. During the rehabilitation program, there were no joint stiffness and the elbow and wrist ROMs were improved.
Conclusion:
Ilizarov reconstruction is a good choice to treat forearm deformity due to multiple heredity exostoses. It has less complications, good outcome, maintain the length of the forearm, good ROM, and good radiographic parameters followed before and after the operation.
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References
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