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Yang H, Qi W, Zhang F, Zhang Q, Liu Y, Lu Z, Mi J, Zhao G. Comparison of diaphyseal and metaphyseal ulnar shortening osteotomies for the treatment of ulnar impaction syndrome. BMC Musculoskelet Disord 2023; 24:10. [PMID: 36609310 PMCID: PMC9817322 DOI: 10.1186/s12891-022-06070-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is a common surgical procedure for the treatment of ulnar impaction syndrome (UIS). The purpose of this study was to compare the results of metaphyseal and diaphyseal USO. METHODS: This retrospective study compared the clinical outcomes and complications of 32 patients who underwent diaphyseal step-cut USO (n = 10), diaphyseal oblique USO (n = 12), or metaphyseal USO (n = 10). RESULTS Patient characteristics, ulnar variance, wrist range of motion, preoperative pain, grip strength, and functional scores (quick disability of the arm, shoulder, and hand and patient-rated wrist evaluation) were comparable. Both operation time (79.5 vs. 138/139 min) and incision length (7.80 vs. 9.67/13.00 cm) were shorter in the metaphyseal USO than in the diaphyseal oblique/step-cut USO. Compared with diaphyseal oblique/step-cut USO, metaphyseal osteotomies were associated with greater improvement in the pain on postoperative day 3 and shorter bone healing time. The requirements for implant removal were the same among the three groups. No complications were observed in any group. CONCLUSION Compared with diaphyseal USO, metaphyseal USO has advantages for operation time and incision length, early postoperative pain, bone healing in UIS management. The results suggested that metaphyseal USO could be widely applied to the surgical treatment of UIS. However, the long-term outcomes of these techniques still require further evaluation using more large-scale, randomized clinical trials.
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Affiliation(s)
- Haoyu Yang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Weiya Qi
- Department of Orthopedics, Xuzhou Renci Hospital, 221000 Xuzhou, China
| | - Fei Zhang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Qian Zhang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Yuzhou Liu
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Zhengfeng Lu
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Jingyi Mi
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Gang Zhao
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
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Teunissen JS, Wouters RM, Al Shaer S, Zöphel OT, Vermeulen GM, Hovius SER, Van der Heijden EPA. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients. J Orthop Traumatol 2022; 23:1. [PMID: 34985595 PMCID: PMC8733117 DOI: 10.1186/s10195-021-00621-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence Therapeutic III. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-021-00621-8.
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Affiliation(s)
- J S Teunissen
- Department of Plastic Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.
| | - R M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S Al Shaer
- Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - O T Zöphel
- Hand and Wrist Centre, Xpert Clinic, Amsterdam, The Netherlands.,Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - G M Vermeulen
- Hand and Wrist Centre, Xpert Clinic, Amsterdam, The Netherlands
| | - S E R Hovius
- Department of Plastic Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.,Hand and Wrist Centre, Xpert Clinic, Amsterdam, The Netherlands
| | - E P A Van der Heijden
- Department of Plastic Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.,Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 'S-Hertogenbosch, The Netherlands
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Notermans BJW, Maarse W, Schuurman AH. A Dorsal Approach for Ulnar Shortening Osteotomy. J Wrist Surg 2018; 7:281-287. [PMID: 30302301 PMCID: PMC6172606 DOI: 10.1055/s-0037-1608636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
Aim This study aims to evaluate the long-term complications, results, and patient satisfaction rates of a dorsally approached ulnar shortening osteotomy for ulnar impaction syndrome. Methods A retrospective chart review of 20 patients was performed. Primary outcomes of interest were subjective, measured using the Patient-Rated Wrist Evaluation (PRWE) score, Disability of the Arm, Shoulder, and Hand (DASH) score, and the third questionnaire about patient satisfaction, composed by the authors. Secondary outcomes included hardware removal due to irritation and other complications. Results Mean postoperative functional score of PRWE was 28 (standard deviation [SD], 30) and DASH 20 (SD, 26), respectively. Fifteen patients were satisfied with the operation. Removal of hardware was noted in six patients. In one patient plate breakage occurred. Conclusion Similar postoperative functional scores and complications were seen in patients undergoing an ulnar shortening osteotomy with a dorsally placed plate for ulnar impaction syndrome, compared with other plate placement localizations. The incidence of plate removal is also comparable to previously described results. As the dorsally placed plate and freehand technique, are relatively easy, we feel that it has a place in the treatment of ulnar impaction syndrome. Level of Evidence Level IV, retrospective cohort study.
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Affiliation(s)
- Bo J. W. Notermans
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| | - Wiesje Maarse
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| | - Arnold H. Schuurman
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
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Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature. Open Orthop J 2015; 9:98-106. [PMID: 26157524 PMCID: PMC4484233 DOI: 10.2174/1874325001509010098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/19/2015] [Accepted: 03/28/2015] [Indexed: 11/22/2022] Open
Abstract
Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure.
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Affiliation(s)
- Katarina Barbaric
- Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 6, 10000, Zagreb, Croatia
| | - Gordan Rujevcan
- Department of Orthopaedic Surgery, General Hospital "Dr. Ivo Pedisic" Sisak, J. J. Strossmayera 59, 44000 Sisak, Croatia
| | - Marko Labas
- Department of Orthopaedic Surgery and Traumatology, General Hospital Varazdin, Ivana Mestrovica 2, 42000 Varazdin, Croatia
| | - Domagoj Delimar
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Salata 6-7, 10000 Zagreb, Croatia
| | - Goran Bicanic
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Salata 6-7, 10000 Zagreb, Croatia
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Oteo J, Benavente P, Merino P. Acortamiento cubital. Contribución del sistema guiado para osteotomía y síntesis. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2015. [DOI: 10.1016/j.ricma.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objetivos: El acortamiento cubital es la técnica quirúrgica empleada más habitualmente para casos de impactación y dolor cubitocarpiano. Tradicionalmente el cúbito ha sido cortado sin guía y la osteosíntesis realizada con una placa no diseñada para esta intervención, pero han surgido sistemas que pretenden facilitar el trabajo al cirujano utilizando guías para la osteotomía y placas de compresión específicas, e intentar mejorar la evolución de los pacientes. El propósito de este estudio es determinar si con el uso de los sistemas guiados se consiguen mejorar los resultados de la técnica previa.Material y método: Entre 2004 y 2008 el acortamiento cubital se realizó en nuestro Centro sin utilizar una técnica guiada, a partir del 2008 se utilizó un sistema guiado. Se ha realizado un estudio descriptivo en 37 casos, 19 no guiados, 18 guiados, revisando el tiempo de duración de la cirugía, el rango de movimiento, el tiempo de consolidación y la retirada del material de osteosíntesis.Resultados: Tras realizar un análisis estadístico de los datos, se ha visto que hay una diferencia estadísticamente significativa en relación con la variable duración de la cirugía, siendo la cirugía guiada veinte minutos más corta que la no guiada. No se han visto diferencias estadísticamente significativas en los otros parámetros.Conclusión: En el acortamiento cubital el uso de los sistemas guiados para corte y osteosíntesis, consigue reducir el tiempo de la cirugía, sin ocasionar detrimento en los resultados en comparación con la técnica sin guía.
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Martin DE, Zlotolow DA, Russo SA, Kozin SH. Comparison of compression screw and perpendicular clamp in ulnar shortening osteotomy. J Hand Surg Am 2014; 39:1558-64. [PMID: 24969590 DOI: 10.1016/j.jhsa.2014.04.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically quantify 2 techniques, compression screw and perpendicular clamp, for generating compression during ulnar shortening osteotomy (USO) in order to promote reliable primary bone healing. METHODS Fourteen fresh-frozen cadaveric human forearms were randomly assigned to 1 of 2 groups. Group I (n = 7) underwent USO according to the traditional AO plate fixation technique using a screw placed eccentrically in an oblong hole to generate compression at the osteotomy site. Group II (n = 7) underwent USO with a commercially available USO plating system using a clamp placed perpendicular to the osteotomy site to generate compression. Both techniques involved a 2-mm resection osteotomy performed with cutting jigs to minimize variability and an interfragmentary lag screw to augment compression. A digital pressure sensor measured contact area at the osteotomy site and average pressure in the observed contact area; these values were used to calculate force across the osteotomy site. Measurements were obtained after the following steps: reduction of osteotomy, compression screw placement (group 1 only), lag screw placement, and final construct with all clamps removed. RESULTS Group II demonstrated significantly greater force than group I, and lag screw placement resulted in significantly increased force independent of fixation technique. The effect of the lag screw on force was maintained after clamp removal. Although technique of fixation did not significantly influence contact area, lag screw placement significantly increased contact area independent of fixation method. However, this effect was not maintained after clamp removal. Average pressure in the observed contact area was not significantly influenced by fixation technique or stage of fixation. CONCLUSIONS Perpendicular clamp compression significantly increased force as compared with traditional compression screw technique, and lag screw placement significantly increased force in both constructs. CLINICAL RELEVANCE Larger compressive forces across the osteotomy may promote primary bone union and decrease the rates of delayed union or nonunion.
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Affiliation(s)
- Daniel E Martin
- Philadelphia Hand Center, Department of Orthopaedic Surgery, Division of Hand Surgery, Thomas Jefferson University, Philadelphia, PA; Upper Extremity Center of Excellence, Shriners Hospitals for Children, Philadelphia, PA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Dan A Zlotolow
- Philadelphia Hand Center, Department of Orthopaedic Surgery, Division of Hand Surgery, Thomas Jefferson University, Philadelphia, PA; Upper Extremity Center of Excellence, Shriners Hospitals for Children, Philadelphia, PA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Stephanie A Russo
- Philadelphia Hand Center, Department of Orthopaedic Surgery, Division of Hand Surgery, Thomas Jefferson University, Philadelphia, PA; Upper Extremity Center of Excellence, Shriners Hospitals for Children, Philadelphia, PA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Scott H Kozin
- Philadelphia Hand Center, Department of Orthopaedic Surgery, Division of Hand Surgery, Thomas Jefferson University, Philadelphia, PA; Upper Extremity Center of Excellence, Shriners Hospitals for Children, Philadelphia, PA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE.
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Abstract
Background The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV.
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Affiliation(s)
- Masahiro Tatebe
- Hand and Microsurgery Center, Anjo Kosei Hospital, Anjo, Japan
| | - Takanobu Nishizuka
- Department of Hand Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Ryogo Nakamura
- Nagoya Hand Center, Department of Orthopedic Surgery, Chunichi Hospital, Nagoya, Japan
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Greenberg JA, Werner FW, Smith JM. Biomechanical analysis of the distal metaphyseal ulnar shortening osteotomy. J Hand Surg Am 2013; 38:1919-24. [PMID: 23978787 DOI: 10.1016/j.jhsa.2013.06.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 06/28/2013] [Accepted: 06/28/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of a closing wedge osteotomy at the distal ulnar metaphysis on unloading the ulnar side of the wrist. METHODS Seven fresh frozen cadaver arms mounted in a wrist simulator were used for the analysis. A 6-degrees-of-freedom load cell was mounted on the distal radius and another on the distal ulna. Radioulnar carpal joint forces and transverse distal radioulnar joint (DRUJ) load were measured at static wrist positions and during dynamic wrist motions before and after the distal metaphyseal ulnar shortening osteotomy (DMUSO) was performed. RESULTS At each static position, significant decreases in ulnar load were noted after DMUSO. In addition, mean and maximum loads decreased for each dynamic wrist motion. There were no statistically significant differences in transverse forces across the DRUJ after DMUSO. CONCLUSION This study showed that DMUSO is an effective way to decrease the load across the ulnocarpal joint. The geometry of the osteotomy and resultant change in the position of the ulnar head did not increase transverse joint reaction forces. CLINICAL RELEVANCE This technique is an alternative to open diaphyseal techniques or methods that damage the articular surface of the distal ulna. Clinical studies will be necessary to associate the biomechanical correction noted in this study with clinical symptom improvement.
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Affiliation(s)
- Jeffrey A Greenberg
- Indiana Hand to Shoulder Center, Indianapolis, Indiana; SUNY Upstate Medical University, Syracuse, New York.
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