CLOSED WEDGE OSTEOTOMY FOR THE CORRECTION OF FOREARM DEFORMITIES IN HEREDITARY MULTIPLE OSTEOCHONDROMA A CASE REPORT.

Abstract

Introduction-Hereditary multiple osteochondroma is rare form of skeletal dysplasia with autosomal inheritance .during childhood ,these cartilage capped bone tumors grow outward from long bone metaphysis ,leading to metaphyseal remodeling and asymmetric longitudinal bone growth. Forearm deformities affect 30% to 60%of patients with HMO. Patient typically complaining of functional disability cosmetic impairment ,and sometimes pain. The deformities may involve a relative shortening ulna bowing of radius, ulnar deviation of the hand and wrist and permanent subluxation or dislocation of radial head. A 15 years old male patient presented Presentation Of Case- with bowing of right forearm with occasionally pain and he also complaining of pain in right shoulder ,knee joint. on a scanogram of right forearm shows ulnar variance -10,radial articular angle 40 degree, radial bowing .07 ,and radial length (121)cm abnormal carpal slip 6 .The patient was managed with surgical intervention. radial osteotomy and resection of osteochondroma and xation with distal radius locking plate and immobilization with long arm cast. patient recover with correction of deformity. The study ndings conrm our hypothesis that radial Discussion- closed wedge osteotomy combined with osteochondroma resection improves the clinical and radiological outcome in this case Masada type 1 deformity (1) increase in the radial articular angle and ulnar variance (2) a decrease in radial ulnar length discrepancy (3) radial shortening (4) correction of carpal slip and bowing of the radius .The decrease in the radial ulnar length discrepancy produced by radial osteotomy probably prevented radial head dislocation because no episode of radial head dislocation was observed due to radial ulnar length discrepancy. This surgical technique is safe and reliable and no episode of necrosis or infection was observed while this technique probably stops the deformity from getting worse. While several treatment Conclusionoption are possible, it make sense to use a simple ,rapid procedure that is not associated with complication or pain-namely radial corrective osteotomy with osteochondroma resection- in children at the end of growth in whom the severe, progressive, radial deformities are associated with HMO.