Benameur Hamza, Bensaleh Souhail, Alidrissi Najib, Jaafar Abdeloihab, Chahbouni Mohammed
Orthopaedics and Traumatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.
Cureus. 2022 Jun 27;14(6):e26361. doi: 10.7759/cureus.26361. eCollection 2022 Jun.
The single-bone forearm is a salvage technique for massive loss of bone due to serious trauma, malignant tumors, infections or congenital deformity. It is also described to treat the sequelae of hereditary multiple exostoses disease that affects the distal end of the ulna. We present the case of a 29-year-old patient, operated for sequelae of hereditary multiple exostoses disease of the left forearm by a modified single-bone forearm technique. The patient, right-handed, operated on twice in childhood for a hereditary multiple exostoses disease of the left forearm: incomplete excision of the exostosis of the distal end of the ulna and lengthening of this last on external fixator, without improvement. The patient presented for a deformation of the left forearm with shortening compared to the right side. Significant limitation of prono-supination (pronation 15°, supination 20°). Elbow flexion at 110° and extension with deficit of 15°. Wrist flexion at 50° and extension at 50°, radial inclination at 25° and ulnar at 30°. The pain score was 3 according to the Visual Analogue Scale (VAS), especially on effort. Dash score was 31,82/100. We chose the forearm technique with a single bone. The immediate postoperative result found a realignment of the forearm, without neurological or vascular damages. Consolidation was obtained in four months. At five months, the patient recovered elbow flexion at 110° and full extension, wrist flexion at 45° and extension at 50°. Radial inclination at 20° and ulnar at 25°. The single-bone forearm technique has been described, not only for the treatment of hereditary multiple exostoses disease, but also for serious trauma or tumors with massive loss of bone. The technique generally consists of an osteotomy of the radius as well as the ulna, fixing the radius to the ulna creating a synostosis, with or without resection of part of one or both bones of the forearm. The most described complications of single-bone forearm procedure are pain, complications related to soft tissue secondary to the previous injury, and infections. The one-bone forearm remain a salvage technique for massive loss of bone of the forearm, or large deformities due to congenital malformations. This technique could allow the excision of massive bone and keep only a part of the ulna and the radius, with function maintenance and aesthetic forearm preservation.
单骨前臂术是一种用于严重创伤、恶性肿瘤、感染或先天性畸形导致的大量骨质缺损的挽救技术。它也被描述用于治疗影响尺骨远端的遗传性多发性骨软骨瘤病的后遗症。我们报告一例29岁患者，采用改良单骨前臂技术治疗左前臂遗传性多发性骨软骨瘤病的后遗症。该患者为右利手，童年时因左前臂遗传性多发性骨软骨瘤病接受过两次手术：尺骨远端骨软骨瘤不完全切除及在外部固定架上对尺骨进行延长，但病情未改善。患者左前臂出现畸形，与右侧相比有缩短。旋前-旋后功能严重受限（旋前15°，旋后20°）。肘关节屈曲110°，伸展有15°的活动度缺失。腕关节屈曲50°，伸展50°，桡偏25°，尺偏30°。根据视觉模拟评分法（VAS），疼痛评分为3分，尤其是在用力时。DASH评分为31.82/100。我们选择了单骨前臂技术。术后即刻结果显示前臂得到了重新排列，无神经或血管损伤。四个月后实现骨愈合。五个月时，患者肘关节屈曲恢复到110°且可完全伸展，腕关节屈曲45°，伸展50°。桡偏20°，尺偏25°。单骨前臂技术不仅被描述用于治疗遗传性多发性骨软骨瘤病，还用于严重创伤或伴有大量骨质缺损的肿瘤。该技术通常包括桡骨和尺骨的截骨术，将桡骨固定于尺骨以形成骨融合，可切除或不切除前臂一根或两根骨头的部分。单骨前臂手术最常描述的并发症是疼痛、与既往损伤继发的软组织相关的并发症以及感染。单骨前臂术仍然是一种用于前臂大量骨质缺损或先天性畸形导致的严重畸形的挽救技术。该技术可以切除大量骨质，仅保留部分尺骨和桡骨，同时维持功能并保留前臂美观。
