Time-lapse technic used to uncover the naturel growth of osteochondromas of the wrist in patients with Hereditary Multiple Osteochondromas

Abstract

Background: In patients with Hereditary Multiple Osteochondromas (HMO) shortening and deformity of the long bones is a well-known sequel. Several theories could clarify the cause of shortening or deformity.

Methods: To reveal the development of the long bones and the influence of the osteochondromas on the growth we used time-lapse technique. Radiographic images, taken for clinical reasons, of 6 HMO affected patients with known osteochondromas on the distal end of the lower arm were selected and adapted to make them suitable for use with a time-lapse technique. The images were placed in chronological order. The ulnar shortening, lunate position and radial inclination were registered, as were the clinical problems. The hypothesis being that slow occurring developmental deformities are easier comprehended and qualitatively studied when the changes are accelerated. 

Results: None of the patients had radial head dislocation at the elbow. The majority of the wrists had decreased ulnar length and increased radial inclination. The clinical problems were limited. The osteochondromatic growth did not seem related to the wrist growth, but when the inclination of the radius was steep osteochondromas were present in the distal radius and the ulna was shortened. Some osteochondromas disappeared.

Conclusions: Time-lapse videos of wrists of patients with HMO showed no relation between growth of wrists and osteochondromas but it did show osteochondromas disappearing. A steep radial inclination seems related to ulnar shortening and might be due to proximity of radial osteochondromas. Patients had marked radiological changes, but relatively few clinical problems.