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Forearm Deformity in Patients with Hereditary Multiple ExostosesFactors Associated with Range of Motion and Radial Head Dislocation
N.D. Clement, MRCSEd1; D.E. Porter, FRCSEd(Tr&Orth)1
1 Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland, United Kingdom. E-mail address for N.D. Clement: nickclement@doctors.org.uk. E-mail address for D.E. Porter: Daniel.Porter@ed.ac.uk
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Investigation performed at the Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, Scotland

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Sep 04;95(17):1586-1592. doi: 10.2106/JBJS.L.00736
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There is a high rate of forearm deformity in patients with hereditary multiple exostoses, with many patients developing radial head dislocation associated with ulnar shortening.


One hundred and six patients with hereditary multiple exostoses who were fifteen years of age or older were identified with use of a previously compiled database. An independent observer measured flexion and extension of the elbow and wrist as well as supination and pronation of the forearm and recorded the number of exostoses affecting the forearm. Proportional ulnar length was calculated as a percentage of the measured height of the patient ([ulnar length/height] ×100).


Exostoses were identified in 183 (86%) of the 212 forearms that were examined. The distal part of the radius was the most common site and was affected in 73% of the patients. One in seven patients had a dislocated radial head, which was associated with reduced proportional ulnar length (p < 0.001). Both radial head dislocation (p < 0.001) and proportional ulnar length (p < 0.001) were confirmed to be independent risk factors associated with forearm rotation on multivariate regression analysis. In conjunction with other risk factors, both of these factors could be used to predict forearm motion. In addition, a reduced proportional ulnar length was also an independent risk factor for radial head dislocation (p < 0.001).


Proportional ulnar length could be used as a tool to identify patients who are at risk for diminished forearm motion and radial head dislocation during childhood. Surgical intervention could potentially be offered before deterioration in function and dislocation of the radial head occurs.

Level of Evidence: 

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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