Single Bone Forearm Research Articles

Case report: Congenital pseudoarthrosis ulna with radial head extrusion

Isolated congenital pseudoarthrosis of the ulna bone is not a common entity. We present such a case of a 13year teenager, she visited us with a deformity of her right forearm (since birth), and extruded forearm bone from the lateral aspect of the elbow joint. The examination and investigation confirmed the diagnosis of congenital pseudoarthrosis of the ulna bone with extrusion of the radial head and we treated her condition by the creation of a single bone forearm as a salvage procedure.

Single-Bone Forearm as a Salvage Procedure in Recalcitrant Pediatric Forearm Pathologies

To report on the outcome of single-bone forearm reconstruction (SBFR) as a salvage procedure in pediatric forearm pathologies. Twenty-eight forearms in 27 patients (median age, 9.6 years; range, 3.4-29.7 years) treated with SBFR at a pediatric referral center were included in the study. Records and radiographs were retrospectively analyzed. Median follow-up was 84 months (range, 24-261 months). The most common underlying condition was multiple hereditary exostoses (MHEs) (17 of 28), followed by brachial plexus birth injury (5 of 28), Ollier disease (2 of 28), congenital radial head dislocation (2 of 28), and others (2 of 28). By 4 months (range, 2-10 months) after surgery, 21 of 28 forearms had united. Median resting postoperative forearm rotation was 10° pronation (range, neutral to 25° pronation). Before surgery, pain was present in 23 of 28 forearms. At the latest follow-up, pain was present in 5 of 28 forearms. In three of the 5 forearms with residual pain, this was attributed to ulnohumeral degenerative changes that existed prior to SBFR. Following SBFR, elbow flexion-extension range was maintained. In the subgroup with MHEs, radial articular angle was maintained (median, 37°-30°) and carpal slip percentage improved significantly (median, 40%-12%). Complications occurred in 8 forearms: 3 cases of nonunion in older patients (age, 30, 20, and 14 years), 2 cases of traumatic juxtaimplant fractures following successful union, 1 case of infection, 1 case of compartment syndrome, and 1 case of persistent radiocapitellar impingement. All complications were successfully treated. When stratified by age, none of the patients in the younger group (16 forearms, age < 12 years) had nonunions or pain at latest follow-up. The SBFR is an old, but generally reliable, option as a single-stage salvage procedure for a number of recalcitrant pediatric forearm pathologies. Success rate may be higher in younger patients. Therapeutic IV.

Soft-Tissue Distraction Prior to Single Bone Forearm Surgery in Ulnar Longitudinal Deficiency: A Report of Two Cases

Ulnar longitudinal deficiency (ULD) is a rare congenital disease of the upper limb. The deformities caused by ULD can be very challenging and may compromise hand function during daily activities. Although the first surgical intervention dates back to the year 1952 there is still no gold standard for treating this uncommon disorder. Two children aged 16 and 3 years with ULD Bayne Type II (partial ulna aplasia) were diagnosed and treated at our department with single bone forearm surgery to achieve stability and improve function using a modified surgical method. For the purpose of an additional gain in limb length and improved cosmesis we used an Ilizarov external fixator for soft tissue distraction including radius distalization prior to the creation of the single bone forearm. This new technique and results are presented and discussed.

Post-osteomyelitic-acquired radial club hand deformity in children treated by centralization of ulna.

Radial club hand deformity acquired post haematogenous osteomyelitis of radius bone is a very rare disease. Resulting in functional and cosmetic deficit of upper limb which is similar to congenital cases. For a long-time various surgeons attempted to reconstruct the deformity by bone grafting, plating, Ilizarov, monorail external fixator, callus distraction and so on. Keeping in mind that creating single bone forearm we proposed centralization of ulna on wrist to correct the deformity. In our institute, we conducted a rare study involving small number of patients ( n = 5), between February 2013 and November 2106. The study participants comprised four male children and one female child whose average age was 1.8 months. Participant inclusion criteria were no active infection, no distal end of radius (cartilage remnant) and only haematogenous osteomyelitis. Exclusion criteria were congenital radial club hand and active infection. Decrease in the angle of radial deviation (radiologically) preoperatively from 54° to 5° and angle of volar flexion from 34° to 4° were measured. Preoperatively no ulnar angulations were observed. Length of ulna remains similar to the opposite side. No neurovascular complication noted and full range of movement regained. Our case series is unique in terms of massive bone loss, that is, distal metaphysic and epiphysis, so we followed the statement of Ono et al. and did centralization of ulna over carpus and achieved good functional and cosmetic outcome at the cost of loss of motion at the wrist, concluding that treatment is primarily considered as salvage only.

Single bone forearm for chronic osteomyelitis of lower third radius

The single bone forearm is a reconstructive procedure for the forearm when other options are not viable and sacrifice of one forearm bone; usually, the radius is necessary to save the forearm. The procedure sacrifices supination and pronation also but it gives a painless stable forearm. We are reporting a case of a 40-year-old female who had chronic osteomyelitis of the distal radius and was treated by single bone forearm surgery.

Acquired Upper Extremity Growth Arrest.

This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10.6 years (range, 0.8-18.2 years) were included in the study. The distal radius was the most common site (n=24), followed by the distal humerus (n=8), metacarpal (n=6), distal ulna (n=5), proximal humerus (n=4), radial head (n=3), and olecranon (n=1). Growth arrest was secondary to trauma (n=22), infection (n=11), idiopathy (n=6), inflammation (n=2), compartment syndrome (n=2), and avascular necrosis (n=1). Twenty-six patients (59%) underwent surgical intervention to address deformity caused by the physeal arrest. Operative procedures included ipsilateral unaffected bone epiphysiodesis (n=21), shortening osteotomy (n=10), lengthening osteotomy (n=8), excision of physeal bar or bone fragment (n=2), angular correction osteotomy (n=1), and creation of single bone forearm (n=1). Four complications occurred; 3 of these required additional procedures. Acquired upper extremity growth arrest usually is caused by trauma or infection, and the most frequent site is the distal radius. Growth disturbances due to premature arrest can be treated effectively with epiphysiodesis or osteotomy. In this series, the specific site of anatomic growth arrest was the primary factor in determining treatment. [Orthopedics. 2017; 40(1):e95-e103.].

Single Bone Forearm for Post Traumatic Bone Defect: A Case Report

Single Bone Forearm for Post Traumatic Bone Defect: A Case Report

Congenital deficiency of distal ulna and dislocation of the radial head treated by single bone forearm procedure.

Congenital deficiency of part of distal ulna affecting the distal radio-ulnar joint is a rare disorder. It is even rarer to find the association of proximal radio-ulnar joint dislocation along with distal ulnar deficiency. This type of congenital forearm anomaly is difficult to treat. Conversion to a single bone forearm in the expense of pronation-supination movement is a viable option. By doing so the elbow and wrist can be stabilized; however movement is possible in only one plane. We are describing here a girl of 8 years having proximal radio-ulnar joint dislocation along with deficiency of distal ulna treated by converting into a single bone forearm.

A Rare Case of Fracture of Radius Associated with Dislocation of Both Distal and Proximal Radio-Ulnar Joint

Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.

Monoaxial distraction of ulna to second metacarpal followed by single bone forearm in massive post infective radial bone loss

Introduction:Radial bone loss associated with gross manus valgus deformity can be managed by open reduction internal fixation using intervening strut bone graft, callus distraction using ring or monoaxial fixator, and achieving union by distraction histogenesis. These methods are particularly suitable when bone loss is small. Single or staged procedure is described for congenital as well as in acquired extensive bone loss of radius. Distraction through radial proximal to distal segments, to achieve reduction of distal radio-ulnar joint (DRUJ), is also described in acquired cases. In the present series, functional results of distraction through ulna to 2nd metacarpal is studied alongwith, functional status of hand, stability of wrist, level of patient's satisfaction are also studied.Materials and Methods:7 unilateral cases of radial loss (M = 5, F = 2) affecting 4 right hands of mean age 17 years (range 9 to 24 years) were included in this study. They were treated by distracting through ulna to 2nd metacarpal to achieve DRUJ alignment in first stage. Subsequently ulna was osteotomised and translated to distal stump of radius. It was then fixed to the distal radial remnant in 30° pronation in dominant and 30° supination non dominant hands.Results:Union was achieved in all cases associated with beneficial cross union of distal ulna. Hand functions improved near to normal, with fully corrected stable wrist joint, hypertrophied ulna and without recurrence. All of them had practically complete loss of forearm rotations, however patients were fully satisfied.Conclusion:This method is particularly suitable when associated with 6 cm or more radial bone loss. But when loss is small, sacrifice of one bone may not be justifiable.

Pseudarthrose congénitale de l’avant-bras. À propos de deux cas et revue de la littérature

Congenital pseudarthrosis of the forearm represents a rare entity which is often associated with neurofibromatosis type I. Isolated pseudarthrosis of the ulna is the most frequent deformity, followed by pseudarthrosis of the radius and both forearm bones. The treatment of these deformities remains difficult: conventional bone grafts rarely lead to complete fusion. The reconstruction by a vascularized fibular graft represents the treatment of choice if the radial head is not dislocated. This procedure allows restoration of a balance between radius and ulna during growth. The presence of a vascularized graft enhances the potential for bony fusion in a fibrous environment. In cases of isolated ulna pseudarthrosis, a luxation of the proximal radial epiphysis may occur when the ulnar deformity increases with time. The single-bone forearm represents a salvage procedure that creates a stable upper limb with a satisfactory wrist and elbow function. The two clinical cases of a pseudarthrosis of both forearm bones and of an ulna pseudarthrosis are presented.

Single-bone Forearm Reconstruction for Malignant and Aggressive Tumors

Limb-salvage surgery for malignant and aggressive forearm tumors presents a unique surgical challenge. We performed single-bone forearm reconstructions after extensive resections of the radius and ulna in four patients for such tumors. Radiocarpal arthrodesis was performed in three patients. We recorded the presence of metastases or local recurrences, Musculoskeletal Tumor Society upper extremity scores, and complications. One patient had local recurrence and one died of metastases. The average Musculoskeletal Tumor Society score at the last followup was 26 of 30 (88%; range, 24-28). Complications included wound infection/necrosis, delayed union, nonunion, and acute carpal tunnel syndrome. Single-bone forearm reconstructive surgery provided satisfactory functional outcomes in these four patients, and we believe it is a reasonable treatment option for individuals with malignant or aggressive tumors of the forearm requiring massive bone resection. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Congenital pseudarthrosis of the ulna

We report a case of congenital pseudarthrosis of the ulna along with generalized neurofibromatosis (type I). The patient had a good clinical outcome after single-bone forearm reconstruction. In the setting of radial head dislocation following long-standing congenital pseudarthrosis of the ulna, single-bone forearm reconstruction is a viable option. It prevents the loss of hand function by the effective shortening of flexor tendons and spares movements of the humeroulnar and radiocarpal joints.

Chronic Osteomyelitis in Children

Summary: In developing countries, chronic osteomyelitis often results from untreated acute hematogenous osteomyelitis but may also be seen as sequelae of trauma (war injuries). This condition is characterized by areas of devitalized bone/soft tissue (sequestra), which serve as a nidus for recurrent episodes of infection. The periosteal response (involucrum) serves to restore structural integrity, and partial or complete reabsorption of sequestra usually accompany this host response. In addition to providing adequate nutritional support, and treating any coexisting medical or infectious diseases, the treatment of chronic osteomyelitis involves surgical removal of all infected/devitalized tissue with or without antibiotic therapy. Sequestrectomy is usually delayed until a suitable involucrum has formed to preserve stability and minimize the chances of fracture and/or segmental bone loss. The disease and/or its treatment may result in focal or segmental loss of bone, requiring further intervention to restore osseous continuity, alignment, and length. Treatment options for focal bone loss include conventional bone grafting and open cancellous bone grafting (subcutaneous bones), and the limb should be protected (cast or external fixator) until healing is complete. For segmental loss of bone, options include conventional bone grafting (external fixator to maintain length and stability) or bone transport. The latter technique, if technically feasible, allows the simultaneous management of limb malalignment and limb length discrepancy. The choice depends on the local resources, and either technique may result in a suitable outcome for the majority of patients. For segmental defects in the tibia, the ipsilateral fibula may be used as a bypass graft. Creation of a single-bone forearm may represent the best option in cases with significant loss of the radius or ulna, provided that the wrist and elbow are normal.

Infected Nonunion of the Long Bones

The problems in infected nonunion include multiple sinuses, osteomyelitis, bone and soft tissue loss, osteopenia, adjacent joint stiffness, complex deformities, limb-length inequalities, and multidrug-resistant polybacterial infection. Bone gap and active infection are the crucial factors relating to treatment and prognosis. Gaps larger than 4 cm likely cannot be effectively bridged by corticocancellous bone grafting. If the limb has intact distal circulation and sensation, limb salvage and reconstruction generally is preferable to amputation. The fracture generally unites if adequate debridement of the nonunion site is done with fracture stabilization and bone grafting. We reviewed 42 consecutive patients with infected nonunion of the long bones. These patients have been categorized into two groups. Type A is infected nonunion of long bones with nondraining (quiescent) infection, with or without implant in situ; Type B is infected nonunion of long bones with draining (active) infection. Both are classified further into two subtypes: 1) nonunion with a bone gap smaller than 4 cm or 2) nonunion with a bone gap larger than 4 cm. Single-stage debridement and bone grafting with fracture stabilization are the methods of choice for Type A1 infected nonunions. Adequate debridement, fracture stabilization, and second-stage bone grafting gives desirable results in Type B1 infected nonunions. Distraction histiogenesis is the preferred procedure for Type A2 and B2. The autogenous nonvascularized fibular graft, posterolateral bone grafting for the tibia, and centralization of the ulna over distal radial remnant (single bone forearm) may be good treatment options in selected cases.

CONGENITAL PSEUDARTHROSIS OF THE ULNA: A CASE REPORT

A case of congenital pseudarthrosis of the ulna is described. The inevitability of dislocation of the radial head in the early years of life, is pointed out. Following dislocation of the radial head, creation of a stable single-bone forearm is necessary to prevent loss of hand function due to effective shortening of the long flexors. A method of radioulnar fusion is described. Following such fusion good hand function can be anticipated, as the vital humeroulna radiocarpal joints are intact.