Background: The effectiveness of excision of osteochondromas in
controlling the progression of forearm and wrist deformity remains an issue of
controversy. The purpose of this study was to analyze the effectiveness of
tumor excision in the correction of forearm and wrist deformity due to
multiple osteochondromas in children, with an interpretation of the results
based on different patterns of deformity.
Methods: Fourteen forearms in thirteen children with a follow-up of
more than twenty-four months (average, fifty-three months) were included in
the study. The forearms were divided into two groups on the basis of the
location of the tumor and the pattern of deformity. In Group 1 (six forearms),
the osteochondroma was only in the distal aspect of the ulna and caused
compression of the radius. In Group 2 (eight forearms), tumors were in both
the distal aspect of the ulna and the ulnar side of the distal part of the
radius and were in contact with each other. Radial length, ulnar shortening,
radial bowing, the radial articular angle, and carpal slip were measured as
radiographic parameters. Ulnar shortening and radial bowing were expressed as
a percentage of the radial length to make it possible to compare data between
the individuals. Each parameter was evaluated before surgery and at the time
of final follow-up.
Results: In Group 1, the percentage of ulnar shortening and the
percentage of radial bowing had improved at the time of final follow-up;
however, in Group 2, both the radial articular angle and the percentage of
radial bowing had deteriorated significantly after the tumor excision (p =
0.049 and p = 0.017, respectively), even though the percentage of ulnar
shortening showed no change.
Conclusions: The effectiveness of simple excision of osteochondromas
of the distal aspect of the forearm is influenced by the tumor location and is
related to the pattern of the deformity. Simple tumor excision can correct the
forearm deformity in patients with an isolated tumor of the distal part of the
ulna. Conversely, in patients with tumors involving the distal part of the
ulna and the ulnar side of the distal end of the radius, tumor excision alone
is a less promising procedure for the correction of the deformity.
Level of Evidence: Prognostic Level IV. See Instructions
to Authors for a complete description of levels of evidence.