Corrective Osteotomy after Gradual Lengthening of the Forearm in Children/Adolescents

We experienced a few unpredictable or unintentional outcomes after gradual lengthening (GL) through distractive osteogenesis (DO) in several etiologies. For deformed forearm bones, we performed an additional delayed corrective osteotomy (DCO). Here, we report the outcomes of two groups according to whether DCO was performed or not, due to unexpected outcomes.

Among children/adolescents treated with GL between 2000 and 2015, we further inspected patients who had unpredictable or unintentional outcomes after GL (Group 1). The patients with satisfactory outcomes were designated as Group 2. Basic demographic data, radiologic findings, and clinical status were evaluated at the final follow-up.

Among 33 patients, 4 patients (12%) with unexpected outcomes were classified as Group 1 (5 lengthenings), and the other 29 patients were classified as Group 2. In comparison of parameters through DO, the mean latent periods, external fixator index, lengthened amount, and healing index were 6.20/6.28 days, 36.24/33.30 days/cm, 26.60/22.31 mm, and 46.40/43.34 days/cm, in Groups 1/2, respectively, without statistical significance. In DCO for 3 patients, the mean age at DCO was 13.7 years, and the mean time since GL was 35.7 months. At final follow-up, the mean bowing angle, distances between the dorsal surfaces of the radius and ulna, and ulnar variances were 4.30/13.79 degrees, 1.73/1.76 mm, and -1.00/- 0.24 mm, in Groups 1/2, respectively, without statistical significance except for the bowing angle. The final ranges of motion arcs were at least good levels without statistical significance in both groups. Additionally, the final visual analog scale (VAS) and disabilities of the arm, shoulder and hand (DASH) scores were all satisfactory, at 0.75 and 1.80/0.48 and 1.05 in Groups 1/2, respectively.

GL of the forearm has been acknowledged as a useful option in several etiologies presenting with a malformed skeleton. Additionally, for uncommon and unpredictable outcomes after GL, a DCO would be a recommended solution. After the DCO, final outcomes are expected to be as satisfactory as the initial predicted outcomes.

Therapeutic level IV.