Case contributed by Manu Bijoor
Diagnosis certain


Palpable bony lump in right distal forearm which has been gradually increasing in size since 2 years and has been experiencing pain since the last 2 months. Patient has no signs of neuorvascular compromise distally in the affected upper limb.

Patient Data

Age: 15
Gender: Male

Pedunculated osteochondroma with medullary continuity arising from the distal radius of right forearm. There is no associated deformity of the ulna or radioulnar joints.

Case Discussion

Osteochondromas involving the forearm commonly cause forearm deformities. The incidence ranges from 40% to 74%. The deformities associated are disproportionate ulnar shortening, radial bowing, subluxation/ dislocation of the radial head, enhanced ulnar variance and functional impairment.

This complex of deformities are similar to Madelung's deformity but does not manifest in the characteristic elongation or dorsal subluxation of the distal ulna.

There is a strong association between the extent of forearm involvement and the general severity of hereditary multiple exostoses.

These deformities are amenable to surgical treatment. Indications for surgery include painful lesions, increasing radial articular angle, progressive ulnar shortening, excessive carpal slip, loss of pronation and dislocation of radial head.

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