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Forearm Deformities in Hereditary Multiple Exostosis: Clinical and Functional Results at Maturity

Litzelmann, Estelle MD*; Mazda, Keyvan MD*; Jehanno, Pascal MD*; Brasher, Christopher MD; Penneçot, Georges-François MD*; Ilharreborde, Brice MD, PhD*

Journal of Pediatric Orthopaedics: December 2012 - Volume 32 - Issue 8 - p 835–841
doi: 10.1097/BPO.0b013e3182694e40

Background: Thirty to 60% of hereditary multiple exostoses patients have forearm deformities. There is no consensus regarding optimal therapy. This long-term retrospective study is the first to compare radiologic and clinical data with patient assessments, to define more precise surgical indications.

Methods: All children presenting with hereditary multiple exostose during the period from 1990 to 2010 were retrospectively analyzed. Masada forearm deformity classification, treatment, clinical course, and radiologic data were included from the preoperative period to the last follow-up. Operated mature patients self-assessed their functional handicap using the QuickDASH score.

Results: Eighteen children (27 forearms) were included. Thirteen of the children had forearm operations, one twice, on the average at 11.1±3 years of age. The average age at last follow-up was 17.6±3.7 years. Data analysis showed no significant functional and radiologic improvement between the early postoperative period and last follow-up. Average QuickDASH score was 15.3±14.9 (out of 100), indicating minor self-assessed handicap despite major clinical and radiologic abnormalities.

Conclusions: Symptomatic radial head instability appears to be an indication for ulnar lengthening surgery. Even severe deformity without dislocation may be managed conservatively given the lack of postoperative functional improvement. Corrective radial osteotomy may be considered near the end of the growth spurt.

Level of Evidence: Level IV.

Departments of *Pediatric Orthopedic Surgery

Pediatric Anesthesiology, Robert Debré Hospital, APHP, Paris, France

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Estelle Litzelmann, MD, Department of Pediatric Orthopedic, Robert Debré Hospital, APHP, Paris 7 University, 48 Bd Sérurier, Paris 75019, France. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.