Treatment strategies for osteochondromas in the distal ulna - a multicentre comparative cohort study

Osteochondromas in the distal ulna of patients with hereditary multiple osteochondromas can cause deformity, radiocapitellar joint incongruency, pain and impaired function. This study compared the long-term outcomes of two different treatment strategies in neighbouring academic hand centres.

One centre used conservative treatment with secondary reconstruction, excising only symptomatic lesions and performing ulnar lengthening for significant shortening. The other centre carried out prophylactic excision of both symptomatic and asymptomatic distal ulnar osteochondromas upon signs of growth disturbance. We included an 11-year consecutive cohort from both centres consisting of 17 patients (25 forearms) treated by conservative treatment with secondary reconstruction and 24 patients (41 forearms) treated by prophylactic excision.

Prophylactic excision resulted in favourable long-term outcomes, including improved function and alignment. Ulnar lengthening in the conservative treatment with secondary reconstruction group could not prevent deformity at skeletal maturity.

These findings indicate a potential advantage of prophylactic excision of distal ulnar osteochondromas in hereditary multiple osteochondromas to prevent progressive deformity and avoid complex secondary procedures.

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