Single-Bone Forearm as a Salvage Procedure in Recalcitrant Pediatric Forearm Pathologies.
PURPOSE
To report on the outcome of single-bone forearm reconstruction (SBFR) as a salvage procedure in pediatric forearm pathologies.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.


TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
['Wang|Kemble K|KK|', 'Vuillermin|Carley B|CB|', 'Waters|Peter M|PM|']
D000293:Adolescent D000328:Adult D002648:Child D002675:Child, Preschool D004551:Elbow Joint D005097:Exostoses, Multiple Hereditary D005542:Forearm D006801:Humans D011884:Radius D016059:Range of Motion, Articular D012189:Retrospective Studies D016896:Treatment Outcome D014457:Ulna D055815:Young Adult
single-bone forearm salvage radial head dislocation Forearm instability osteochondromatosis