FOREARM LENGTHENING IN CHILDREN: REVIEW OF 22 CASES

This study retrospectively reviews all forearm lengthenings carried out by the author in order to assess results and complications and determine the efficacy of this treatment in children with various pathologies. The records of all patients who had undergone a forearm lengthening between 1995 and 2009 were reviewed. 23 forearm lengthenings in 20 patients were identified but in one case there was insufficient information for the study. The study is therefore based on 22 lengthenings. The patients were divided into two groups, Group A in whom the purpose of treatment was to restore the length relationship between the radius and ulna and Group B in whom the purpose was to gain forearm length. In Group A patients the aim was to protect the radial head against dislocation by lengthening the ulna (with if necessary a corrective radial osteotomy) or to protect the wrist from subluxation by a radial lengthening. In Group B patients the aim was to improve function and cosmesis. The average age of the patients at time of surgery was 9.78 years, average follow up was 26 months post frame removal. There were 11 patients in Group A with an average radio ulnar discrepancy of 2.34 cms and 11 patients in Group B. In Group A patients the average length achieved was 2.69 cms i.e. overcorrection and in Group B the average lengthening was 3.84 cms. In Group A patients lengthening was only partially successful at preventing subluxation or dislocation of the radial head. Common complications were pin site infection and poor regenerate formation. Forearm lengthening by distraction osteogenesis is a worthwhile procedure in paediatric patients with improved cosmesis and function particularly in Group B patients.