Single-Bone Forearm Reconstruction

Carley Vuillermin

Operative Indications

Severely maligned forearm with dislocated radial head proximally and distal radioulnar joint (DRUJ) at wrist (Figure 12.1)
- Most commonly secondary to multiple exostosis/osteochondromatoses, but also with Ollier multiple enchondromatoses, neuropathic conditions such as brachial plexopathy and cerebral palsy, and congenital dislocations
This operation is highly effective for the severe deformity, especially in the young, as a single-stage reconstruction with low chance of future surgery

Figure 12-1 ▪ Anteroposterior (AP) (A) and lateral (B) radiographs of chronic forearm deformity from osteochondromatosis with dislocated radial head at elbow and distal radial-ulnar joint at wrist.

Figure 12-2 ▪ Photograph of dislocated radial head and malaligned forearm in a 2-year-old child for single-bone reconstruction at early age. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Alternative Treatments

Natural history
Skeletal realignment with corrective osteotomies, bone lengthening, and joint reduction of radiocapitellar joint, proximal radioulnar joint, and distal radioulnar joint (DRUJ) in similar cases of severe skeletal imbalance and joint dislocations
- Frequent repeat surgeries throughout growth

Positioning

Supine with radiolucent arm and hand table

Surgical Approach

Extensile exposure for the entire length of forearm from elbow to wrist (Figure 12.3)
- Proximal curvilinear aspect of incision allows for anconeus posterolateral approach to radiocapitellar joint
- Incision straightens out and extends distally along the ulnar border to the level of DRUJ
  - Elevation of periosteum for the entire length of ulna, with circumferential diaphyseal exposure
  - Proximal Kocher exposure of dislocated radial head
  - Protect posterior interosseous nerve
  - Distal exposure to ulnar head protecting triangular fibrocartilage complex (TFCC)
  - Protect dorsal ulnar sensory nerve

Figure 12-3 ▪ Extensile incision outlined for complete exposure for proximal radial head resection; diaphyseal realignment, bone grafting, and fixation; and distal ulna resection. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Technique in Steps (

Video)