The single-bone forearm is a salvage technique for massive loss of bone due to serious
trauma, malignant
tumors,
infections or congenital
deformity. It is also described to treat the sequelae of
hereditary multiple exostoses disease that affects the distal end of the ulna. We present the case of a 29-year-old patient, operated for sequelae of
hereditary multiple exostoses disease of the left forearm by a modified single-bone forearm technique. The patient, right-handed, operated on twice in childhood for a
hereditary multiple exostoses disease of the left forearm: incomplete excision of the
exostosis of the distal end of the ulna and lengthening of this last on
external fixator, without improvement. The patient presented for a deformation of the left forearm with shortening compared to the right side. Significant limitation of prono-supination (pronation 15°, supination 20°). Elbow flexion at 110° and extension with deficit of 15°. Wrist flexion at 50° and extension at 50°, radial inclination at 25° and ulnar at 30°. The
pain score was 3 according to the Visual Analogue Scale (VAS), especially on effort. Dash score was 31,82/100. We chose the forearm technique with a single bone. The immediate postoperative result found a realignment of the forearm, without neurological or vascular damages. Consolidation was obtained in four months. At five months, the patient recovered elbow flexion at 110° and full extension, wrist flexion at 45° and extension at 50°. Radial inclination at 20° and ulnar at 25°. The single-bone forearm technique has been described, not only for the treatment of
hereditary multiple exostoses disease, but also for serious
trauma or
tumors with massive loss of bone. The technique generally consists of an
osteotomy of the radius as well as the ulna, fixing the radius to the ulna creating a
synostosis, with or without resection of part of one or both bones of the forearm. The most described complications of single-bone forearm procedure are
pain, complications related to soft tissue secondary to the previous injury, and
infections. The one-bone forearm remain a salvage technique for massive loss of bone of the forearm, or large
deformities due to congenital malformations. This technique could allow the excision of massive bone and keep only a part of the ulna and the radius, with function maintenance and aesthetic forearm preservation.