Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 10 , ISSUE 2 ( August, 2015 ) > List of Articles


Reconstruction of the DRUJ in a young adult after resection of a large exostosis of the distal radius

Bas R. J. Aerts, E. J. M. van Heeswijk, Annechien Beumer

Keywords : Distal radioulnar joint, Forearm, Osteocartilaginous exostoses, Osteochondroma, MO, Reconstruction

Citation Information : Aerts BR, van Heeswijk EJ, Beumer A. Reconstruction of the DRUJ in a young adult after resection of a large exostosis of the distal radius. 2015; 10 (2):123-127.

DOI: 10.1007/s11751-015-0224-4

License: CC BY-NC-SA 4.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2015; The Author(s).


The prevalence of known solitary exostosis is around 1–2 % in the general population. Treatment of an exostosis may consist of resection with or without further treatment for deformity. The distal radioulnar joint (DRUJ) acts as the link between radius and ulna at the wrist and is important in the transmission of load. Its anatomic integrity should be respected in surgical procedures or ulnar-sided wrist pain because of instability, limitation of forearm rotation and potential development of grip weakness may develop. We present a case of reconstruction of the DRUJ with distraction lengthening of the ulna after resection of a large exostosis of the distal radius that had resulted in a malformed and dysplastic ulna. This treatment in a young patient resulted in a stable, functional and congruent distal radioulnar joint.

PDF Share
  1. Trebicz-Geffen M, Robinson D, Evron Z, Glaser T, Fridkin M, Kollander Y, Vlodavsky I, Ilan N, Law KF, Cheah KS, Chan D, Werner H, Nevo Z (2008) The molecular and cellular basis of exostosis formation in hereditary multiple exostoses. Int J Exp Pathol 89:321-331
  2. Bovee JV (2008) Multiple osteochondromas. Orphanet J Rare Dis 3:3
  3. Jennes I, Pedrini E, Zuntini M, Mordenti M, Balkassmi S, Asteggiano CG, Casey B, Bakker B, Sangiorgi L, Wuyts W (2009) Multiple osteochondromas: mutation update and description of the multiple osteochondromas mutation database (MOdb). Hum Mutat 30:1620-1627
  4. Zhang F, Liang J, Guo X, Zhang Y, Wen Y, Li Q, Zhang Z, Ma W, Dai L, Liu X, Yang L, Wang J (2013) Exome sequencing and functional analysis identifies a novel mutation in EXT1 gene that causes multiple osteochondromas. PLoS ONE 8:e72316
  5. Legeai-Mallet L, Munnich A, Maroteaux P, Le Merrer M (1997) Incomplete penetrance and expressivity skewing in hereditary multiple exostoses. Clin Genet 52:12-16
  6. Wicklund CL, Pauli RM, Johnston D, Hecht JT (1995) Natural history study of hereditary multiple exostoses. Am J Med Genet 55:43-46
  7. Schmale GA, Conrad EU 3rd, Raskind WH (1994) The natural history of hereditary multiple exostoses. J Bone Joint Surg Am 76:986-992
  8. Verhaar J (2008) Orthopedie. Bohn Stafleu van Loghum, Houten
  9. Pedrini E, Jennes I, Tremosini M, Milanesi A, Mordenti M, Parra A, Sgariglia F, Zuntini M, Campanacci L, Fabbri N, Pignotti E, Wuyts W, Sangiorgi L (2011) Genotype-phenotype correlation study in 529 patients with multiple hereditary exostoses: identification of “protective” and “risk” factors. J Bone Joint Surg Am 93:2294-2302
  10. Roehl HH, Pacifici M (2010) Shop talk: sugars, bones, and a disease called multiple hereditary exostoses. Dev Dyn 239:1901-1904
  11. Vogt B, Tretow HL, Daniilidis K, Wacker S, Buller TC, Henrichs MP, Roedl RW, Schiedel F (2011) Reconstruction of forearm deformity by distraction osteogenesis in children with relative shortening of the ulna due to multiple cartilaginous exostosis. J Pediatr Orthop 31:393-401
  12. Hill RA, Ibrahim T, Mann HA, Siapkara A (2011) Forearm lengthening by distraction osteogenesis in children: a report of 22 cases. J Bone Joint Surg Br 93:1550-1555
  13. Matsubara H, Tsuchiya H, Sakurakichi K, Yamashiro T, Watanabe K, Tomita K (2006) Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses. J Orthop Sci 11:459-466
  14. Ip D, Li YH, Chow W, Leong JC (2003) Reconstruction of forearm deformities in multiple cartilaginous exostoses. J Pediatr Orthop B 12:17-21
  15. Mader K, Gausepohl T, Pennig D (2003) Shortening and deformity of radius and ulna in children: correction of axis and length by callus distraction. J Pediatr Orthop B 12:183-191
  16. Pritchett JW (1986) Lengthening the ulna in patients with hereditary multiple exostoses. J Bone Joint Surg Br 68:561-565
  17. Waters PM, Van Heest AE, Emans J (1997) Acute forearm lengthenings. J Pediatr Orthop 17:444-449
  18. Shaaban H, Giakas G, Bolton M, Williams R, Scheker LR, Lees VC (2004) The distal radioulnar joint as a load-bearing mechanism—a biomechanical study. J Hand Surg Am 29:85-95
  19. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602-608
  20. Kitamura T, Moritomo H, Arimitsu S, Berglund LJ, Zhao KD, An KN, Rizzo M (2011) The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am 36:1626-1630
  21. Noda K, Goto A, Murase T, Sugamoto K, Yoshikawa H, Moritomo H (2009) Interosseous membrane of the forearm: an anatomical study of ligament attachment locations. J Hand Surg Am 34:415-422
  22. Peterson BM, McCarroll HR Jr, James MA (2007) Distraction lengthening of the ulna in children with radial longitudinal deficiency. J Hand Surg Am 32:1402-1407
  23. Taghinia AH, Al-Sheikh AA, Panossian AE, Upton J (2013) Two-stage distraction lengthening of the forearm. J Craniofac Surg 24:79-84
  24. Goldstein RY, Jordan CJ, McLaurin TM, Grant A (2013) The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Joint Dis 71:96-103
  25. Shin EK, Jones NF, Lawrence JF (2006) Treatment of multiple hereditary osteochondromas of the forearm in children: a study of surgical procedures. J Bone Joint Surg Br 88:255-260
  26. Demir B, Gursu S, Ozturk K, Yildirim T, Konya MN, Er T (2011) Single-stage treatment of complete dislocation of radial head and forearm deformity using distraction osteogenesis in paediatric patients having multiple cartilaginous exostosis. Arch Orthop Trauma Surg 131:1195-1201
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.