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Case Reports
. 2018 Apr;7(2):160-164.
doi: 10.1055/s-0037-1606562. Epub 2017 Sep 7.

Ulnar Lengthening/Reconstruction of Interosseous Membrane in Treatment of Osteochondroma

Marcio Aurelio Aita  1 , Fabio Lucas Rodrigues  2 , Rodrigo Montemor Bernardo  2 , Daniel Rebolledo  2 , Danilo Barronovo  2 , Gustavo Mantovanni Ruggiero  3
Affiliations
Case Reports

Ulnar Lengthening/Reconstruction of Interosseous Membrane in Treatment of Osteochondroma

Marcio Aurelio Aita et al. J Wrist Surg. 2018 Apr.

Abstract

Background: We aim to measure the quality of life and clinical and functional outcomes of a patient who had undergone ligament reconstruction of the forearm interosseous membrane, using brachioradialis tendon more ulna distraction osteogenesis in treatment with multiple cartilaginous exostosis.

Case description: We present a 11-year-old boy with congenital deformity in his right, dominant forearm,Type IIb by Masada classification. Distraction of the ulna, resection of exostosis, and reconstruction of the distal part of the interosseous membrane was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 60 degrees and supination was 90 degrees. Elbow flexion was 120 degrees, extension was -5 degrees, and digit motion was full. DASH score of 5, VAS of 0, and grip strength of 92% compared to the unaffected side were obtained. Forearm radiographic aspects showed healing of the distraction, articular congruency, the distal radioulnar joint (DRUJ), and radiocapitellum joint. The distraction distance was 28 mm, the distraction period was 67 days, the consolidation period was 96 days, and the period of fixator treatment was 92 days. The distraction speed was 0.5 mm/day. Good stability and joint congruency of the DRUJ and elbow were obtained. Good radiographic, clinical, and functional results were obtained improving the life quality of that patient.

Literature review: The treatment of forearm deformities is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the timing of the intervention have been a matter of controversy in the literature. Would DRUJ be stable when ulnar lengthening is combined with excision of exostosis? Is it possible to reduce the radial head with this technique?

Clinical relevance: We would like to suggest an interosseous membrane (distal oblique band) reconstruction to improve this treatment. We believe this suggestion could maintain DRUJ and elbow more stable and functional. We agree that the best time to perform the corrections is early and gradually. We prefer to correct the ulna, radius, DRUJ and elbow in many steps than in only one procedure.

Keywords: forearm deformity; interosseous membrane reconstruction; multiple osteochondromas; relative ulnar shortening; wrist deformity.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Schematic drawing of the Masada classification for forearm deformity in patients with multiple osteochondromas.
Fig. 2
Fig. 2
Forearm radiograph aspect: Preoperative.
Fig. 3
Fig. 3
Forearm radiographic aspect: Monolateral lengthening fixator was mounted onto ulna.
Fig. 4
Fig. 4
Intraoperative aspect showed the brachioradialis tendon graft dissected.
Fig. 5
Fig. 5
Schematic drawing and intraoperative aspect: Pass brachioradialis tendon graft into radius/ulna tunnels to substitute the distal oblique band by an interosseous membrane.
Fig. 6
Fig. 6
Forearm radiographic aspect: Postoperative showed external fixator in ulna, radial head reduction, distal radioulnar joint congruency, and callus in maturation.
Fig. 7
Fig. 7
Forearm radiographic aspect: Postoperative showed callus healing and good relationship between the forearm bones and elbow distal radioulnar joint.
Fig. 8
Fig. 8
Clinical aspects: 1 year postoperatively.
Fig. 9
Fig. 9
Radiograph forearm aspect: Preoperative and postoperative.
See this image and copyright information in PMC

References

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