Forearm lengthening: management of elbow and wrist

The risk and consequences of an elbow or a wrist contracture are lower during a forearm lengthening than during a lower limb lengthening. This kind of complication can mostly be avoided by an active and intensive regimen of physiotherapy. However, there are some challenges to deal with in treating the disorder multiple exostoses and the radial club hand, including the lack of consensus on the best treatment for multiple exostoses. However, it is important to realize that the evolution of multiple exostoses can lead to a radial head dislocation which will damage the pronation and the supination range of motion. As this motion can be poor even without a radial head dislocation as a result of the radius being longer than the ulna, an interesting technique can be to lengthen the ulna to limit this phenomenon. In radial club hand, the main problem is the deviation of the hand requiring a centralization. The best treatment for centralization of the hand is to do a progressive correction with an external fixator. Thereafter, it is possible to lengthen the forearm, but this indication is mainly cosmetic in the unilateral radial club hand.