DEFORMITY CORRECTION AND LENGTHENING WITH EXTERNAL FIXATION IN THE FOREARM BONES DISCREPANCY

Abstract

Purpose: Surgical treatment with circular external fixation of forearm deformities and shorthening in patients with congenital and posttraumatic pathologies 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 patients. We review the results of correction of deformities and length discrepancies of the forearm using circular external fixator.

Methods and Materials: We evaluated the results of distraction lengthening in 25 forearms of 24 patients with forearm shortening and deformity. The mean age at the time of surgery was 18.2 years (range 6 to 55 years). Etiologies were: congenital radioulnar synostosis and deformity of the forearm (2), multiple hereditary exostoses (3), distal radial physeal arrest (2), Madelung’s deformity (5), congenital shortening of both bones (1), radial clubhand with Bayne type I deficiency (2), pseudoartrosis (6), malunion correction (3), Forearm Elongation After Hand Replantation (1). The ulna was involved in 14 cases and the radius in 11. The lengthening technique consisted in a subperiosteal osteotomy and progressive distraction after 5 days of waiting period. In majority of cases the deformity and shortening of ulna and radius were different, for this reason we use separate system for lengthening and correction for each bone. That permits to correct wrist deformity and restore normal relationships in the distal radioulnal syndesmosis.

Results: All 25 forearms were reviewed at a mean 28,6 months. Mean lengthening was 31.2 mm (range 10 – 68 mm). One patient that in the pass was treated with monolateral fixator, had other two subsequent lengthening and obtains normal length of forearm. One patient has radial nerve palsy after 21 days of distraction. Reducible claw fingers completely regressed after interruption of the lengthening were observed in 4 cases. There were 2 cases with an axial deviation at the end of lengthening and 2 cases of late healing resolving without a secondary bone graft. The healing index was 49.8 days per cm gained length.

Conclusion: Lengthening of the forearm was found to improve upper extremity function and appearance of the arm with satisfaction of all patients.