ABSTRACT
BACKGROUND: We aim to measure the quality of life and clinical and functional outcomes of a patient who had undergone ligament reconstruction of the forearm interosseous membrane, using brachioradialis tendon more ulna distraction osteogenesis in treatment with multiple cartilaginous exostosis. CASE DESCRIPTION: We present a 11-year-old boy with congenital deformity in his right, dominant forearm,Type IIb by Masada classification. Distraction of the ulna, resection of exostosis, and reconstruction of the distal part of the interosseous membrane was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 60 degrees and supination was 90 degrees. Elbow flexion was 120 degrees, extension was -5 degrees, and digit motion was full. DASH score of 5, VAS of 0, and grip strength of 92% compared to the unaffected side were obtained. Forearm radiographic aspects showed healing of the distraction, articular congruency, the distal radioulnar joint (DRUJ), and radiocapitellum joint. The distraction distance was 28 mm, the distraction period was 67 days, the consolidation period was 96 days, and the period of fixator treatment was 92 days. The distraction speed was 0.5 mm/day. Good stability and joint congruency of the DRUJ and elbow were obtained. Good radiographic, clinical, and functional results were obtained improving the life quality of that patient. LITERATURE REVIEW: The treatment of forearm deformities is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the timing of the intervention have been a matter of controversy in the literature. Would DRUJ be stable when ulnar lengthening is combined with excision of exostosis? Is it possible to reduce the radial head with this technique? CLINICAL RELEVANCE: We would like to suggest an interosseous membrane (distal oblique band) reconstruction to improve this treatment. We believe this suggestion could maintain DRUJ and elbow more stable and functional. We agree that the best time to perform the corrections is early and gradually. We prefer to correct the ulna, radius, DRUJ and elbow in many steps than in only one procedure.
ABSTRACT
OBJECTIVE: This study aimed to demonstrate that the lengthening technique of an external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. METHODS: From January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 cm were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. RESULTS: The mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6.66 months (consolidation index 43 days per cm). Initial mean knee range of motion was -1° to 100°, progressing to 0°-115° at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decreased knee range of motion, and need for locking screw removal. CONCLUSION: Femur lengthening with a monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.
OBJETIVO: Demonstrar que a técnica de alongamento do fixador externo associado a haste intramedular bloqueada é eficaz e traz benefícios quanto ao tempo de uso do fixador e a melhoria na reabilitação. MÉTODO: Entre janeiro de 2005 e maio de 2014 foram tratados 31 pacientes com discrepância de membros inferiores com média de encurtamento de 5,31 cm. As etiologias da deformidade foram sequelas de fratura de fêmur, infecção, displasia de desenvolvimento do quadril, paralisia infantil e fêmur curto congênito. RESULTADOS: O tempo médio de fixação externa foi de 2,47 meses (índice de fixação externa de 16,15 dias por centímetro). O tempo médio necessário para consolidação óssea foi 6,66 meses (índice de consolidação 43 dias por centímetro). A amplitude de movimento do joelho média inicial era de -1 a 100 graus e no término do tratamento de 0 a 115 graus. As complicações observadas foram osteotomias incompletas, subluxação de quadril, quebra do fixador, limitação da amplitude do joelho e necessidade de retirada de material. CONCLUSÃO: A técnica de alongamento femoral com fixador externo monolateral sobre haste intramedular propicia um tempo menor de uso do fixador externo, melhor proteção do regenerado ósseo e reabilitação precoce, não isenta de complicações.
ABSTRACT
ABSTRACT OBJECTIVE: This study aimed to demonstrate that the lengthening technique of an external fixator associated with locked intramedullary nail is an efficient method that decreases the duration of the external fixation and improves the rehabilitation period. METHODS: From January of 2005 to May of 2014, 31 patients with mean lower limb discrepancy of 5.31 cm were treated. The etiologies of the deformity were femur fracture sequelae, infection, hip development dysplasia, polio, and congenital short femur. RESULTS: The mean duration of external fixation was 2.47 months (external fixation index of 16.15 days per cm). The mean time for bone healing was 6.66 months (consolidation index 43 days per cm). Initial mean knee range of motion was -1° to 100°, progressing to 0°-115° at the end of treatment. The complications observed were incomplete osteotomies, hip subluxation, broken fixator, decreased knee range of motion, and need for locking screw removal. CONCLUSION: Femur lengthening with a monoplanar external fixator associated with locked intramedullary nail allowed for a shorter period of external fixation use, better protection for the regenerated bone tissue, and early rehabilitation with possible complications.
RESUMO OBJETIVO: Demonstrar que a técnica de alongamento do fixador externo associado a haste intramedular bloqueada é eficaz e traz benefícios quanto ao tempo de uso do fixador e a melhoria na reabilitação. MÉTODO: Entre janeiro de 2005 e maio de 2014 foram tratados 31 pacientes com discrepância de membros inferiores com média de encurtamento de 5,31 cm. As etiologias da deformidade foram sequelas de fratura de fêmur, infecção, displasia de desenvolvimento do quadril, paralisia infantil e fêmur curto congênito. RESULTADOS: O tempo médio de fixação externa foi de 2,47 meses (índice de fixação externa de 16,15 dias por centímetro). O tempo médio necessário para consolidação óssea foi 6,66 meses (índice de consolidação 43 dias por centímetro). A amplitude de movimento do joelho média inicial era de -1 a 100 graus e no término do tratamento de 0 a 115 graus. As complicações observadas foram osteotomias incompletas, subluxação de quadril, quebra do fixador, limitação da amplitude do joelho e necessidade de retirada de material. CONCLUSÃO: A técnica de alongamento femoral com fixador externo monolateral sobre haste intramedular propicia um tempo menor de uso do fixador externo, melhor proteção do regenerado ósseo e reabilitação precoce, não isenta de complicações.