Background: Surgical treatment of forearm deformities in patients
with multiple cartilaginous exostoses remains controversial. The purpose of
the present study was to determine the reasonable indications for operative
treatment and to evaluate long-term results of forearm surgery in these
Methods: We retrospectively reviewed twenty-three patients
(thirty-one forearms) after a mean duration of follow-up of nearly thirteen
years. The mean age at the time of the initial procedure was eleven years. The
patients underwent a variety of surgical procedures, including excision of
exostoses; corrective procedures (lengthening of the radius or ulna and/or
corrective osteotomy of the radius and/or ulna) and open reduction or excision
of a dislocated radial head. Clinical evaluation involved the assessment of
pain, activities of daily living, the cosmetic outcome, and the ranges of
motion of the wrist, forearm, and elbow. The radiographic parameters that were
assessed were ulnar variance, the radial articular angle, and carpal slip.
Results: Four patients had mild pain, and five patients had mild
restriction of daily activities at the time of follow-up. Eight patients
stated that the appearance of the forearm was unsatisfactory. Radiographic
parameters (ulnar variance, radial articular angle, carpal slip) were
initially improved; however, at the time of the final follow-up visit, the
deformities had again progressed and showed no significant improvement. The
only procedure that was associated with complications was ulnar lengthening.
Complications included nonunion (three forearms), fracture of callus at the
site of lengthening (two forearms), and temporary radial nerve paresis
following an ulnar distraction osteotomy (one forearm). Excision of exostoses
significantly improved the range of pronation (p = 0.036).
Conclusions: In our patients with multiple cartilaginous exostoses,
corrective osteotomy and/or lengthening of forearm bones was not beneficial.
The most beneficial procedure was excision of exostoses. Reasonable
indications for forearm surgery in these patients are (1) to improve forearm
rotation and (2) to improve the appearance.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.