Open Access
Table 2
Interventions and outcomes.
| Author:Year [Reference] | Operative procedure (forearms) | Preoperative radiography | Postoperative radiographyμ | Preoperative clinical tools | Postoperative clinical outcomeμ | Complications* |
|---|---|---|---|---|---|---|
| Cho:2014 [19] | Osteochondroma excision (ulna), gradual mid-diaphyseal ulnar lengthening + 5 mm overlengthening, multiplanar Ilizarov external fixator (3). | Radial articular angle, radial length, radial bowing, percentage of radial bowing, carpal slip, ulnar length, ulnar shortening, percentage of ulnar shortening & radial head stability | Statistically non-significant improvement of all indices | Patient-reported functional assessment scale, & ROM | All patients were satisfied, statistically non-significant improvement of ROM | Callus fracture, & asymptomatic resubluxation of radial head (1 each). |
| D'Ambrosi:2016 [15] | Osteochondroma excision (ulnas), gradual middiaphyseal ulnar lengthening, uniplanar external fixator (15), +/− distal radioulnar synostosis separation. | Radial articular angle, carpal slip, ulnar shortening, radial head dislocation, & relative ulnar shortening | Statistically significant improvement of all indices. Carpal slip remained in 3/7 cases. | Patient-reported functional assessment scale, ROM, MAYO Elbow Score, VAS, SF-12 | All patient-reported and physician-reported parameters showed a statistically significant improvement. | Non-union successfully treated by bone grafting & compression plate fixation (1). |
| Demir:2011 [39] | Osteochondroma excision (2 ulnas, 1 radius), gradual mid-diaphyseal/proximal ulnar lengthening, uniplanar external fixator, +/− radial osteotomy (2). | Radial articular angle, carpal slip, ulnar variance, radial bowing. MRI, CT scanning and bone scintigraphy were also used | Significant improvement of all indices but statistical significance was not used. | Patient-reported assessment scales for daily life activities, pain, cosmetic, DASH & ROM | All patient-reported parameters & ROM improved and all patients were satisfied with their cosmetic outlook. Only one patient reported mild pain. | Callus fractures successfully treated by plating & intramedullary fixation (2). |
| Vogt:2011 [21] | Gradual diaphyseal ulnar lengthening, uniplanar orthofix external fixator (12), +/− osteochondroma excision (5 ulnas), +/− proximal radioulnar synostosis resection (1) +/− radial osteotomy (4). | Radial articular angle, ulnar shortening, carpal slip, radial head dislocation | Radial articular angle & ulnar shortening showed a statistically significant improvement. Carpal slip disappeared in 3/5 cases and asymptomatic radial head dislocation persisted in all 5 cases. | ROM only | Forearm: 41% improved, 25% deteriorated, 4% unchanged. Elbow & wrist flexion/extension: 84% unchanged, 1 case improved and another deteriorated. Wrist adduction/abduction: 59% improved & 41% unchanged. | Premature callus Consolidation successfully treated with repeat corticotomy (1). |
| Tang:2013 [41] | Osteochondroma excision (ulna), gradual distal ulnar osteotomy & lengthening +/− 5 mm overlengthening, uniplanar external fixation (14). | Radial articular angle, radial bowing, percentage of ulnar shortening, & carpal slip†. | Radial articular angle & carpal slip improved in all but 2 cases. Ulnar shortening was corrected in all cases. | Objective & subjective assessment of wrist function for: percentage of grip power, ROM, pain & activity of hand. | All but 2 cases had no limitation of daily activities, 4 cases reported mild pain. All ROM parameters in forearm and biplane wrist motion improved except for (1) case. Overall scores: 10 excellent & 4 good. | Malunion was reoperated successfully (1), refracture after fixator removal managed conservatively (1). |
| Masada:1989 [3] | Osteochondroma excision (12 ulnas & 2 radiuses), gradual ulnar lengthening with external fixator (3) & acute with bone graft (10), radial osteotomy (10), distal radius hemiepiphysiodesis (2), open reduction of dislocated radial head (2). | Radial articular angle, carpal slip, ulnar shortening. Relative radial shortening was measured for type III | Ulnar length was restored in all but one forearm. Radial articular angle & carpal slip improved in all cases. | ROM | Forearm rotation improved dramatically in all cases. | Recurrence of ulnar shortening (2), proximal radio-ulnar synostosis, transient radial nerve palsy (1 each). |
| Beutel:2014 [20] | Gradual ulnar lengthening with multiplanar external fixator (1). | Ulnar shortening, ulnar bowing, posterolateral radial head near dislocation were seen. MRI revealed entrapment of the annular ligament within the radiocapitellar joint, osteochondral impaction injuries of the anterior radial head, capitellum & injuries of the anterior trochlea and coronoid process. | Ulnar length & bow were restored & radial head relocated. MRI was not conducted postoperatively. | ROM & pain | Complete restoration of elbow ROM & resolution of pain. Forearm was unaffected preoperatively. | None |
| Hill:2011 [22] # | Osteochondroma excision, gradual ulnar lengthening (proximal diaphyseal), uniplanar, multiplanar Ilizarov or spatial/Ilizarov hybrid external fixator (5), & open reduction of radial head with neck osteotomy (1). | Radial articular angle, ulnar shortening, radial head dislocation | 2 dislocated radial heads remained so, 1 dislocated & 1 subluxed after initially being located and 1 remained located before & after surgery. | Degree of deformity was recorded pre & postoperatively but No values or final outcomes were provided | NR | Poor callus regenerate successfully treated.# |
| Litzelmann:2012 [7] | In mild deformity: isolated osteochondroma excision (3 radiuses). Isolated radial osteotomies (2). In moderate deformity typically >11 y old: corrective distal 1/3 radial osteotomy with acute ulnar lengthening + bone grafting (3). In severe deformity: gradual ulnar lengthening over Intramedullary pin at diaphyso-metaphyseal junction, uniplanar external fixator (7) (4 with radial osteotomy & 3 with osteochondroma excision). | Radial articular angle, carpal slip, radial epiphyseal angle, ulnar variance, radial bowing & radial head dislocation assessed by Storen line. | Non-significant improvement of all radiologic parameter was noted. Two of the 5 dislocated radial heads preoperatively remained so postoperatively. | ROM, pain, Patient-reported functional assessment: QuickDASH. | ROM did not show statistically significant improvement. One out of the 3 patients with radial head instability & pain preoperatively remained so postoperatively and required a successful radial head resection at age 17 years. QuickDASH. Showed a significant improvement. | Revision surgeries at age 17y for deformity recurrence (2) (1 radial head resection & 1 radial osteotomy), fracture callus at 2 years postoperative (1). |
| Jiya:1997 [11] | Isolated osteochondroma excision (4), acute ulnar lengthening with screw fixation, osteochondroma excision (8), +/− radial osteotomy. | Linear axis, radial articular angle, carpal slip, ulnar shortening | Radial articular angle, carpal slip improved in most forearms or remained unchanged. Ulnar shortening was frequent. | NR (only chief complaints were recorded) | NR | Recurrence of ulnar shortening (5), reoperation for recurrent exostosis (1), reoperation for fracture/ non-union of callus to solid union (2). |
| Shin:2006 [10] | Isolated osteochondroma excision (11) (6 ulnas & 5 radiuses). Osteochondroma excision & ulnar lengthening (4) (2 gradual with uniplanar fixator & 2 acute), osteochondroma excision with Sauvé-Kapandji procedure (7). | Linear axis, radial articular angle, carpal slip, ulnar shortening | Isolated osteochondroma excision & ulnar lengthening: statistically non-significant improvement. Sauvé-Kapandji: Statistically significant improvement | ROM in forearm & elbow | Osteochondroma excision & ulnar lengthening: statistically non-significant improvement. Sauvé-Kapandji: Statistically significant improvement | 36.4 % recurrence after simple osteochondroma excision (all required reoperations). Open reduction for persistently symptomatic radial head dislocation after ulnar lengthening (2). Reoperations for recurrent osteochondroma after Sauvé-Kapandji (2). |
| Rasool:2008 [31] | One-bone forearm (radioulnar fusion) (2). | Radial articular angle, carpal slip & ulnar shortening | Residual ulnar shortening in one forearm | ROM, grip strength | Both patients significantly improved in elbow, forearm rotation & grip strength | None |
| Pritchett:1986 [26] | Gradual mid-diaphyseal ulnar lengthening, uniplanar external fixator (6). Acute ulnar lengthening (4) including (2 with iliac crest graft and plate fixation & 2 over Rush rods). +/− radial osteotomy (5). | Radial articular angle, carpal slip, relative ulnar shortening, | Of the 6 subluxed/dislocated radial heads preoperative, 5 became stable postoperative. | ROM | ROM improved in most forearms | Recurrence of ulnar shortening (6), especially children & young adolescents, asymptomatic ulnar non-union & deep infection (1 each). |
| Massobrio:2015 [27] | Simultaneous gradual proximal ulna and distal radius lengthening with uniplanar external fixator (2). | Radial articular angle, carpal slip, ulnar shortening, relative ulnar shortening & radial length | Significant improvement in all measurements | Function, ROM & cosmetic | Significant improvement in ROM & function | None |
| Kelly:2016 [28] | Distal radius hemiepiphysiodesis (15). | Radial articular angle, carpal slip, ulnar tilt, lunate subsidence, metaphyseal epiphyseal angle | Statistically significant improvement in all 5 measurements except lunate subsidence | NR | NR | None |
| Tonogai:2015 [18] | Osteochondroma excision & interosseous membrane dissection, gradual ulna (2) or radial (1) lengthening, multiplanar Ilizarov or uniplanar fixator. | Radial articular angle, ulnar shortening | Improved | ROM | Improved | None |
| Refsland:2016 [14] | Gradual mid-diaphyseal Ulnar lengthening with uniplanar external fixator (17), +/− osteochondroma excision (14), +/− radial osteotomy (5). | Radial articular angle, carpal slip, radius of curvature, ulnar variance, angle of the radial and ulnar physes, elbow carrying angle, amount of radial head coverage | Statistically significant improvement in radius of curvature, ulnar variance, carrying angle, radial head coverage | ROM & pain | Statistically non-significant improvement in ROM & 5 patients who had pain preoperative had no pain postoperative. | Osteotomy for deformity recurrence (1), external fixator failure requiring exchange (2), premature consolidation (1). |
| Bauer:2017 [17] | Gradual ulna lengthening (1). Combined ulna & radius osteotomies (2) | Angular & rotational deformity of radius & ulna | Statistically significant improvement | ROM in rotation | Statistically significant improvement | Extensor pollicis Longus weakness (1). |
| Yang:2013 [34] | Reconstruction of the distal ulnar epiphysis by vascularized proximal fibula with epiphysis (2). | Radial articular angle, carpal slip & relative ulnar shortening | Significant improvement (persistent but asymptomatic radial head dislocation) | Function, pain ROM & cosmetic | Significant improvement | None |
| Bilen:2009 [23] | Osteochondroma excision, gradual ulnar lengthening multiplanar (2) or uniplanar (6) external fixator +/− radial osteotomy. Lengthening was Rush rods guided in (2) cases. | Radial articular angle, carpal slip & ulnar shortening | Significant improvement & all radial heads that were dislocated preoperative were reduced. | NR | Significant improvement but no goniometric measurements conducted | None |
| Mader:2003 [40] | Osteochondroma excision, gradual ulnar lengthening, uniplanar fixator (4). | Radial articular angle, carpal slip & ulnar shortening | Significant improvement | ROM, function. | Significant improvement | None |
| Peterson:2008 [32] | One-bone forearm (radioulnar fusion) (1). | Previous resection of distal ulna & radial head dislocation | Restoration of forearm length discrepancy. | ROM & stability in elbow | Significant improvement | None |
| Eralp:2016 [16] | Osteochondroma excision, gradual mid-diaphyseal ulnar lengthening, uniplanar external fixator (4) (over Steinman in 2 cases) and combined radius osteotomy. | Ulnar shortening, radial bow | Restoration of ulnar shortening & radial bow. | Daily life activities | Significant improvement | Recurrent radial deformity (1). |
| Waters:1997 [13] | Acute ulnar lengthening with plate fixation (17), osteochondroma excision (12) & radial osteotomy (11). | ulnar shortening, ulnar variance, radial inclination, radial articular angle, carpal slip (AP and lateral), forearm-third metacarpal angle, status of ossification of radial & ulnar physes, radial-head subluxation & congruence of the distal radioulnar joint. | Significant improvement | ROM | Most patients improved | Reoperations with bone graft for non/delayed union & broken plate (3), progressive radial head subluxation (1), annular ligament reconstruction (2), chronic elbow pain (2), creation of one-bone forearm (1), repeat lengthening (2). |
| Ip:2003 [30] | Osteochondroma excision, gradual ulnar lengthening, multiplanar or uniplanar external fixator or acutely with plating (6), & radial osteotomy (5) based on definite radiographic criteria. | Radial articular angle, carpal slip & ulnar shortening, relative ulna shortening | Significant improvement | ROM, subjective simple questionnaire to assess satisfaction | Significant improvement in ROM & all parents were satisfied with function & cosmetic. | Radial head dislocation during lengthening (1) was successfully reduced by pin stabilization. |
| Song:2013 [6] | Gradual ulnar lengthening with multiplanar external fixator & monofocal ulnar osteotomy (13), +/− radial osteotomy (5), +/− osteochondroma excision (4). | Radial articular angle, carpal slip & ulnar shortening, relative ulna shortening | Statistically significant improvements & the only dislocated radial head preoperative was reduced postoperative. | Subjective quality of life questionnaire, functional limitation of motion & pain | Most patients were satisfied with forearm appearance, had no pain on strenuous activities & could manage activities daily life activities easily. | Recurrence of osteochondroma & deformity (2), delayed union/nonunion (2). |
| Akita:2007 [8] | Isolated osteochondroma excision (13). Osteochondroma excision & ulnar lengthening (18) (8 gradual with uniplanar external fixator & 10 acute with bone graft), +/− gradual radial lengthening (4), +/− ulna osteotomy (2), +/− radial osteotomy (14), +/− open reduction radial head (2). | Radial articular angle, carpal slip & ulna variance | Statistically non-significant improvement of all measurements | Subjective quality of life questionnaire, pain, ROM & grip strength | Statistically non-significant improvement in ROM & grip strength. Most patients were pain free & had no restrictions of daily activities. Unsatisfactory cosmetic appearance (8). | Nonunion successfully treated with bone graft and internal fixation (3), fracture callus (2), temporary radial nerve paresis (1) & symptomatic radiocapitellar joint (2). |
| Matsubara:2006 [24] | Osteochondroma excision, gradual ulnar lengthening, uniplanar or multiplanar external fixator (7), +/− radial osteotomy (5), +/− gradual radius lengthening (2). | Radial articular angle, carpal slip, ulna variance & radial bow. | Recurrence of ulnar shortening in (5) cases. The other measurements improved moderately. | ROM & pain | Significant improvement in pain & forearm rotation except one case. | Recurrence of ulnar shortening (5) one of which was relengthened. Radial head subluxation (1). |
| Ishikawa:2007 [9] | Isolated osteochondroma excision (14) (6 from distal ulna & 8 from distal ulna + radius. | Radial articular angle, carpal slip, ulnar shortening, radial length, radial bowing. | Excision from distal ulna: statistically significant improvement in ulnar shortening, radial bow only. Excision from distal ulna + radius: non-significant improvement and/or deterioration in all measurements. | NR | NR | Osteochondroma recurrence of various degrees (7) (2 from ulna & 5 from ulna + radius). |
| Cheng:1991 [25] | Gradual ulnar lengthening with uniplanar external fixator without bone graft (4). | Ulnar length only | Satisfactory corrected | ROM, cosmetic | Non-significant improvement in ROM, but improved cosmetic & daily life activities. | None |
| Rodgers:1993 [33] | One-bone forearm (radioulnar fusion) with a pin or plate (2), +/− gradual lengthening & radial osteotomy (1). | Radial articular angle, carpal slip & ulnar shortening | Significant improvement except for residual ulnar shortening in (1) case. | ROM, activities of daily life | Satisfactory in elbow & wrist, returned to full-time manual occupation/competitive sports. | None |
| Irani:1993 [43] | Isolated osteochondroma excision from ulna & radius (8), gradual ulnar lengthening with uniplanar fixator (2) & bone graft with plating + radial osteotomy (1). | Ulnar shortening, & radial head subluxation/dislocation (3) | Relocated & asymptomatic | ROM | No improvement in forearm rotation | None |
| Fogel:1984 [12] | Isolated excision of the osteochondromas (ulna or radius) (12), acute ulnar lengthening & excision osteochondroma (2), acute ulnar lengthening, excision osteochondroma, & distal radius hemiepiphysiodesis (7). Fixations were with plate/rush rod, +/− bone graft. | Radial articular angle, carpal slip & ulnar shortening | Isolated excision: no improvement in radial articular angle & carpal slip. Ulnar lengthening & excision: no improvement. Ulna lengthening, excision & distal radius hemiepiphysiodesis: significant improvement. | ROM, pain & cosmetic. | Isolated excision: no improvement in neither rotation nor ulnar shortening but significant improvement in pain, no osteochondroma recurrence. Ulnar lengthening & excision: no improvement. Ulna lengthening, excision, & distal radius hemiepiphysiodesis: significant improvement. | None |
| Arms:1997 [29] ∞ | Osteochondroma excisions (36), radial-head excisions (6), distal radius hemiepiphysiodesis (5), distal radial osteotomies (2), and ulnar lengthenings with external fixators (4). Combined procedures performed on a single patient in (11) occasions. | Radial articular angle, carpal slip, relative ulnar shortening, and forearm-third metacarpal angle. | Majority of patients demonstrated radiographic abnormalities | Telephone patient-reported questionnaire of quality of life | Majority of patients were in full-time jobs with minimal impact on activities of daily life. | NR |
N number, NR not reported, ROM range of motion in forearm & elbow, +/− wrist, VAS visual analog scale, SF-12 a quality of life scale that measures physical and mental components, DASH disabilities of the arm, shoulder and hand score.
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