Our Experience in Correction of Forearm Deformities in Patients with Multiple Hereditary Exostoses

Background: Surgical treatment of forearm deformities in patients with multiple hereditary exostoses remains controversial. Patients with MHE have multiple cartilage-capped exostoses that may be sessile or pedunculated. Osteochondromas of the upper extremities commonly cause forearm deformities. Masada has popularized a classification for MHE. The prevalence of such deformities is as high as 40% to 74%. We report our experience in correction of forearm deformation in patients with hereditary multiple exostoses.

Methods: We retrospectively reviewed six patients (four males, two females) after a mean duration of follow-up of nearly eight years. The mean age at the time of the initial procedure was ten years. The patients underwent a variety of surgical procedures, including excision of exostoses; corrective procedures (lengthening of the 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, and radio-capitellar congruency, pre and post operatively.

Results: Three patients stated that the appearance of the forearm was unsatisfactory. In four patients the forearm range of motion has improved. Radiographic parameters (ulnar variance, radial articular angle, carpal slip) were improved in all. Two cases needed ulnar lengthening. Complications included delayed union (one forearm), and temporary radial nerve paresis following an ulnar distraction osteotomy (one forearm). Excision of exostoses significantly improved the range of pronation and supination (p = 0.036).

Conclusions: In our patients with MHE, corrective osteotomy and/or lengthening and excision of exostoses of forearm bones was beneficial. We could: (1) improve forearm rotation and motion at the elbow (2) improve the appearance and patient satisfaction and (3) improve stability.