3D Planning and Forearm Deformity Correction in Adolescents with Multiple Exostosis – Clinical Results

Abstract

Despite the 30% to 60% of patients with Multiple cartilaginous exostoses (MCE) showing forearm deformity, there is still no consensus regarding the preferred method and ideal timing of treatment, especially in teenage patients with multiple injuries in whom the treatment timing can have a strong psychological impact because disorder of endochondral bone growth can lead to joint instability and severe deformities of the involved extremity. Ulna lengthening, radius osteotomy, Distal radio ulnar joint (DRUJ) stabilization, and radial head reduction may be a good strategy to correct upper limb deformity. This study was to show reproducible planning and procedure to correct radius deformity, subluxation of the radio capitellar joint, ulna minus, carpal balance, and DRUJ incongruence in adolescents treated with ABC protocol (hybrid external fixation and volar radius plate using 3D model and software planning system methods) in Five adolescents with MCE and forearm deformity. After 1 year of the surgery, patients showed a DASH score was 8 and a VAS score was 1. On X-ray examination, Radial articular angle (RAA) = 21.55°, Palmar tilt =10°, ulnar variance (UV) = 1.2 mm, carpal slip (CS) = 64%, center of rotation of angulation (CORA) = 1.1° to ulna / 21.95° to radius and radial bowing (RB) = 11.45mm. The complication rate was 20% (one patient) and submitted ulna re-lengthening for improving DRUJ congruence. ABC protocol (hybrid external fixation and volar radius plate using a 3D model and software planning system) was found to be a safe and reliable treatment method for forearm deformity in adolescents with MCE.

Keywords

3D planning - bone lengthening - congenital - deformity correction - deformity planning - elbow - osteochondromaity - relative ulnar shortening - wrist deformity

Informed Consent

An informed consent document was provided to all research participants, who read and signed it according to their will. The research presented here was approved by and was in accordance with the ethical standards of the Faculdade de Medicina do ABC Ethics Committee on human experimentation by n° 1750176. An informed consent document was provided to the patient, who read and signed it according to his will.

Publication History

Received: 13 March 2024

Accepted: 11 October 2024

Article published online:
23 December 2024

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