title: Single-stage treatment of complete dislocation of radial head and forearm deformity using distraction osteogenesis in paediatric patients having multiple cartilaginous exostosis.
abstract: BACKGROUND
  We are reporting the results of single-stage treatment for patients with forearm deformity and radial head luxation due to hereditary multiple exostosis using distraction osteogenesis.
  
  
  METHODS
  Six patients with a mean age of 12 years were treated. Morphological evaluation was made according to Masada (3 of the cases were 2a and 3; 2b). Angular deformities of forearm and wrist were evaluated as described by Fogel (distal radial joint angle was 27°, ulnar variance was 12.8 mm and carpal slip was 71.3%). Mean forearm pronation was 48.4° whilst mean supination was 19.2°. Mean elbow range of motion was 26.6°-103.4° and the mean DASH score was 75. Common surgical procedures were deformity correction, ulnar lengthening and gradual radial head reduction using external fixators.
  
  
  RESULTS
  Mean follow-up period was 4.2 years and mean external fixation time was 6 months. Mean amount of ulnar lengthening was 2.9 cm and the distraction index was 14.9 cm/day. Mean radial articular angle was 14.3°, ulnar variance 2.3 mm, carpal slip 55%, forearm pronation 65.9° and supination was 55°. Mean elbow range of motion was 15.8°-119.2°. In the last follow-up, the mean value of DASH score was 8.1. Major and minor complications were seen during the follow ups.
  
  
  CONCLUSIONS
  Single-stage deformity correction, ulnar lengthening and radial head reduction technique that we have used provide satisfactory functional and cosmetic results. Early surgical correction may lead to even better results.
authors.affiliation: Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey. bilalbirkandemir@yahoo.com
authors.forename: Bilal
authors.initials: B
authors.lastname: Demir
authors.forename: Sarper
authors.initials: S
authors.lastname: Gursu
authors.forename: Kahraman
authors.initials: K
authors.lastname: Ozturk
authors.forename: Timur
authors.initials: T
authors.lastname: Yildirim
authors.forename: Mehmet Nuri
authors.initials: MN
authors.lastname: Konya
authors.forename: Turgay
authors.initials: T
authors.lastname: Er
mesh_terms: D000293:Adolescent; D002648:Child; D004551:Elbow Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005097:Exostoses, Multiple Hereditary / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000473:pathology / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D011884:Radius / Q000473:pathology / Q000601:surgery; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014457:Ulna / Q000473:pathology / Q000601:surgery