1
|
Fuchs J, Spühler DL, Luz S, Zdravkovic V, Hainich J. Corrective osteotomy of the distal radius with palmar locking plate osteosynthesis without bone grafting and without cortical contact. J Hand Surg Eur Vol 2024; 49:359-365. [PMID: 37310077 DOI: 10.1177/17531934231179875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The aim of this study was to assess bone healing and secondary fracture displacement after corrective osteotomy of the distal radius without any cortical contact using palmar locking plates without bone grafting. Between 2009 and 2021, 11 palmar corrective osteotomies of extra-articular malunited distal radius fractures and palmar plate fixations without the use of bone grafts and without cortical contact, were assessed. All patients showed complete osseous restoration and significant improvement in all radiographic parameters. Except for one patient, there were no secondary dislocations or loss of reduction in the postoperative follow-up. Bone grafts may not be mandatory for bone healing and prevention of secondary fracture displacement after palmar corrective osteotomy without cortical contact and fixation with palmar locking plate.Level of evidence: IV.
Collapse
Affiliation(s)
- Johannes Fuchs
- Hand, Plastic and Reconstructive Surgery, Cantonal Hospital St. Gallen, Switzerland
| | | | - Stephanie Luz
- Hand, Plastic and Reconstructive Surgery, Cantonal Hospital St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, Switzerland
| | - Jörg Hainich
- Hand, Plastic and Reconstructive Surgery, Cantonal Hospital St. Gallen, Switzerland
| |
Collapse
|
2
|
Rodriguez-Fontan F, Lauder A. Managing the Extra-Articular Distal Radius Malunion. Hand Clin 2024; 40:63-77. [PMID: 37979991 DOI: 10.1016/j.hcl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Distal radius fractures are common injuries. Satisfactory outcomes are typically achieved with appropriate nonoperative or operative treatment. A proportion of these injuries develop symptomatic malunions, which may be treated surgically with distal radius corrective osteotomy. A thorough understanding of the anatomy, biomechanics, radiographic parameters, and indications is needed to provide appropriate treatment. Factors, including surgical approach, osteotomy type, use of bone graft, fixation construct, management of associated tendon and/or nerve conditions, soft tissue contracture releases, and need for ulnar-sided procedures, should be considered. A comprehensive evaluation is necessary to guide understanding for when salvage procedures may be preferred.
Collapse
Affiliation(s)
- Francisco Rodriguez-Fontan
- Department of Orthopedics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Alexander Lauder
- Department of Orthopedics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA; Department of Orthopedics, Denver Health Medical Center, Denver, CO, USA.
| |
Collapse
|
3
|
WINGE MI, RØKKUM M. Calcium phosphate bone cement and metaphyseal -corrective osteotomies in the upper extremity: long-term follow-up of 10 children. Acta Orthop 2022; 93:769-774. [PMID: 36161337 PMCID: PMC9511366 DOI: 10.2340/17453674.2022.4589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The evaluation of metaphyseal angular deformities in children includes indication and timing for corrective osteotomy, and possible need for several operations during growth. Gap-fillers are usually autologous bone grafts, which might cause donor site problems. Calcium phosphate (CaP) bone cement may be a possible alternative. PATIENTS AND METHODS We performed 15 corrective osteotomies from 2007 to 2013 in 10 children, ages 5 to 18, with Norian SRS bone cement as a gap-filler, in the distal radius (12), proximal radius (1), and proximal humerus (2). Due to growth arrest and gradually increasing malalignments 3/10 children needed 1-3 additional corrections. Locking plates and screws were used except in 1 case at first surgery, aged 5 (K-wires). 2 children needed additional limb lengthening with external fixator. RESULTS All osteotomies healed. Postoperative radiographs and CT scans showed good alignment and gradual transformation of cement into bone. Remodeling was visible intraoperatively in patients needing multiple surgeries. Return to earlier osteotomy sites was unproblematic. No adverse events from using CaP cement were experienced. INTERPRETATION CaP cement is an alternative to bone grafts in upper extremity metaphyseal corrective osteotomies in children, and also when greater corrections are necessary or several surgeries indicated during the growth period.
Collapse
Affiliation(s)
- Mona I WINGE
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne RØKKUM
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Zhang H, Zhu Y, Fu F, Gou L, Zhu Y, Zhang Z, Zhou C, Yao S, Yue M, Li X, Tong P, Ruan H, Wu C. Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra-Articular Fracture of the Distal Radius: A Retrospective Study. Orthop Surg 2022; 14:1751-1758. [PMID: 35866348 PMCID: PMC9363726 DOI: 10.1111/os.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Although corrective osteotomy with volar or dorsal plate fixation can treat malunion of distal radius fractures, each has its own disadvantages. Little is currently known on whether dorsal fixation combined with volar fixation may further improve recovery. This study aimed to evaluate the clinical value of corrective osteotomy combined with volar and dorsal plate fixation in patients with malunion of intra-articular fractures of the distal radius. METHODS Seventeen patients with malunion of intra-articular fractures of the distal radius treated with corrective osteotomy with volar and dorsal plate fixation from 1 January 2016 to 31 November 2018 were retrospectively analyzed. The enrolled patients included seven males and 10 females with an average age of 54.9 years (range: 36-70 years). The radiographic parameters, including the radial length, the radial inclination angle, the ulnar variance, and the volar tilt, as well as clinical outcomes, including wrist and forearm range of motion (ROM), grip strength, the Mayo Modified Wrist Score (MMWS), and the disabilities of the Arm, Shoulder, and Hand (DASH) score, were examined at 3 months and 18 months after operation and compared with the preoperative state. The paired t-test was used for statistical analysis. RESULTS After corrective osteotomy combined with volar and dorsal plate fixation, all included patients were followed up for 18 months, and there was no surgical site infection. Patients reported postoperative pain due to the irritation of extensor tendon (two cases) and wrist arthritis (two cases). The radial length increased from 1.34 ± 2.34 mm to 9.25 ± 2.65 mm and 9.03 ± 2.47 mm at 3 months and 18 months postoperatively (t = 8.257, 7.954, all p < 0.05). The radial inclination angle increased from 6.45° ± 0.76° to 19.35° ± 3.43° and 19.03° ± 3.63° at 3 and 18 months (t = 12.517, 12.122, all p < 0.05). The ulnar variance decreased from 5.11 ± 0.23 mm to 1.32 ± 0.31 mm and 1.54 ± 0.62 mm at 3 and 18 months (t = 4.214, 4.895, all p < 0.05). The volar tilt was corrected from 4.47° ± 3.46° to 15.51° ± 2.72° and 14.12° ± 2.41°, respectively (t = 11.247, 10.432, all p < 0.05). Moreover, wrist ROM increased from 42.53° ± 8.99° to 98.70° ± 7.61° and 101.24° ± 7.66° (t = 41.433, 46.627, all p < 0.05), while forearm ROM was increased from 94.82° ± 6.54° to 134.47° ± 5.06° and 137.24° ± 5.52°, respectively (t = 31.507, 32.584, all p < 0.05). Similarly, grip strength, MMWS, and DASH were also remarkably improved. There were no significant differences in the wrist and forearm ROM, grip strength, MMWS, and DASH scores between follow-up at 3 and 18 months (all p > 0.05). CONCLUSIONS Corrective osteotomy with volar and dorsal fixation can improve recovery of volar tilt, relieve wrist pain, restore wrist and forearm function, and increase grip strength of patients with malunion of intra-articular fractures of the distal radius.
Collapse
Affiliation(s)
- Huihao Zhang
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Yong Zhu
- Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Fangda Fu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingyun Gou
- Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Yonglin Zhu
- Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Zhiguo Zhang
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengcong Zhou
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Sai Yao
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ming Yue
- Department of Physiology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaofeng Li
- Department of Orthopedics and Traumatology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peijian Tong
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongfeng Ruan
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengliang Wu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
5
|
Uemura T, Yano K, Takamatsu K, Miyashima Y, Yasuda H, Konishi S, Nakamura H. Bone healing of distal radius nonunion treated with bridge plating with bone graft substitutes in combination with systemic romosozumab administration: A case report. Jt Dis Relat Surg 2021; 32:526-530. [PMID: 34145834 PMCID: PMC8343859 DOI: 10.52312/jdrs.2021.82661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 11/21/2022] Open
Abstract
Romosozumab is a humanized, anti-sclerostin monoclonal antibody used to treat osteoporosis, which increases bone formation and decreases bone resorption. It enhances fracture healing and systemic romosozumab administration may have therapeutic potentials for accelerating bone healing of even nonunion. Herein, a 61-year-old heavy smoker male with distal radius nonunion who achieved successful bone union by combination therapy of romosozumab and spanning distraction plate fixation with bone graft substitutes was presented. Through the dorsal approach, atrophic comminuted nonunion of the distal radius was sufficiently debrided. Reduction of the distal radius was performed using indirect ligamentotaxis, and a 14-hole locking plate was fixed from the third metacarpal to the radial shaft. A beta (β) tricalcium phosphate block was mainly packed into the substantial metaphyseal bone defect with additional bone graft from the resected ulnar head. Postoperatively, systemic administration of monthly romosozumab was continued for six months. Complete bone union was achieved 20 weeks postoperatively and the plate was, then, removed. Wrist extension and flexion improved to 75o and 55o, respectively, without pain, and grip strength increased 52 weeks postoperatively from 5.5 kg to 22.4 kg. During romosozumab treatment, bone formation marker levels increased rapidly and finally returned to baseline, and bone resorption marker levels remained low. In conclusion, combination of systemic romosozumab administration and grafting β-tricalcium phosphate with bridge plating provides an effective treatment option for difficult cases of comminuted distal radius nonunion with risk factors such as smoking, diabetes, and fragility.
Collapse
Affiliation(s)
- Takuya Uemura
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | | | | | | | | | | | | |
Collapse
|
6
|
Andreasson I, Carlsson G, Kjellby-Wendt G, Karlsson J, Fagevik Olsén M. Daily life one year after corrective osteotomy for malunion of a distal radius fracture an interview study. J Plast Surg Hand Surg 2021; 56:16-22. [PMID: 33726632 DOI: 10.1080/2000656x.2021.1899934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to explore the everyday life experiences of people one year after corrective osteotomy following a symptomatic, malunited, distal radius fracture.Semi-structured interviews were conducted with twenty respondents, median age 65 (22-81) years. The respondents were recruited consecutively. The interviews were subjected to qualitative content analysis. Three authors took part in the analysis.The result is presented as one theme, 'Daily life works again' with five categories: Relief of inconveniences and symptoms, Managing new symptoms and complications, Regaining abilities, Normalised social relationships, Increased wellbeing. The symptoms had declined in severity, some participants regarded themselves as fully restored and used their hand again without hesitation. Others were still bothered by their wrist occasionally and a few had to manage complications. The participants had regained the ability to perform many everyday life activities and reported increased independence and less irritation between spouses, as well as increased wellbeing.One year after a corrective osteotomy following malunion of a distal radius fracture, the patients' experiences represent a continuum. Some are still restricted by their wrist occasionally, the majority experience an increased ease in their performance of activities of daily life and some regard themselves as fully restored. The recovery has a positive impact on social relationships and the patients' wellbeing.
Collapse
Affiliation(s)
- Ingrid Andreasson
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Carlsson
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Physiotherapy, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Monika Fagevik Olsén
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Physiotherapy, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
7
|
Cognet JM, Mares O. Distal radius malunion in adults. Orthop Traumatol Surg Res 2021; 107:102755. [PMID: 33316441 DOI: 10.1016/j.otsr.2020.102755] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
Distal radius malunion (DRMU) consists in a non-anatomical consolidation of a distal radius fracture. The resulting alteration of the articular or extra-articular radial anatomy impairs wrist function to a greater or lesser degree: Restricted ranges of motion, loss of strength, pain. There may also be nerve or tendon involvement. Adaptive carpal malalignment and ulnar-carpal impingement are also possible. Imaging assessment should at least include X-ray and CT; CT-arthrography is essential in intra-articular DRMU, which regularly progresses toward radiocarpal osteoarthritis. Surgical indications are guided by clinical assessment. Restoring distal radial anatomy requires osteotomy, according to type of DRMU: anterior or posterior opening or closing wedge. Bone or bone-substitute graft may need to be associated. Computerisation has improved planning and should be implemented, whenever possible. Ulnar osteotomy may be performed, isolated or associated to distal radial osteotomy. Palliative partial fusion or bone resection is possible in case of joint involvement or in patients with low functional demand.
Collapse
Affiliation(s)
- Jean-Michel Cognet
- SOS Mains Champagne Ardennes, clinique Courlancy, 38 bis, rue de Courlancy, 51100 Reims, France.
| | - Olivier Mares
- Service de chirurgie orthopédique et traumatologique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| |
Collapse
|
8
|
Katt B, Seigerman D, Lutsky K, Beredjiklian P. Distal Radius Malunion. J Hand Surg Am 2020; 45:433-442. [PMID: 32220492 DOI: 10.1016/j.jhsa.2020.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
Malunion remains the most common complication of nonsurgical treatment of fractures of the distal radius and represents a common clinical entity. Symptomatic treatment often involves corrective osteotomy. Surgical correction is a challenging problem with unpredictable clinical outcomes. Prevention of malunion of a distal radius fracture is the best course of action. With maintenance of volar cortical contact and the use of volar fixed-angle devices, bone grafting may not be necessary in certain cases of malunion correction. New technologies such as 3-dimensional modeling and computer-generated osteotomy guides are likely to have a positive impact on the outcomes of surgical treatment.
Collapse
Affiliation(s)
- Brian Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA.
| | - Daniel Seigerman
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| |
Collapse
|
9
|
Yaradılmış YU, Tecirli A, Örs Ç. Distal radius correction osteotomy with tricortical bone graft is a successful method in heavy smokers. J Orthop 2020; 18:150-154. [PMID: 32021022 DOI: 10.1016/j.jor.2019.09.006] [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: 07/14/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Corrective osteotomy is a technically challenging surgical option to improve wrist function in tilted distal radius malunions. However fracture healing in smokers is adversely affected. The aim of this study was to evaluate the clinical and radiological effect of cigarettes on bone union in heavy-smokers who underwent corrective osteotomy with a triangular bone graft harvested from the iliac crest. METHOD Fifteen patients, who were treated using trapezoidal block grafts taken from the iliac crest, who were smokers of 20 or more cigarettes daily (heavy smokers) with no chronic disease, and who consented to participate in the study. Fifteen non-smoker patients of the same age group were determined as the control group. Radiological measurements were made to include radial inclination and ulnar variance in pre-operative and post-operative radiographs. Functional evaluation was performed using Q-DASH and MAYO hand-wrist scores. RESULTS In both groups, the mean age of the patients was 49,1 ± 3,92 years. Smokers group the bone union in the osteotomy line was observed after 16,63 (12-24 h) weeks, non-smokers grup 14.1 (12-24) weeks (p = 0.06). Range of motion is found similar clinic between in groups (p > 0.05). Q-DASH for group smokers was 17.54 ± 1.85, nonsmokers 17.20 ± 1.24 (p = 0,878); MAYO was 82.27 ± 6.06 for 82.00 ± 7.74 (p = 0.874). for group B. No statistically significant difference was noted between the groups. CONCLUSION Our study showed that cigarette smoking did not have negative effect on union time in the metaphyseal region after correction osteotomy. The time of bone-union in heavy-smokers was 2.5 weeks more than that of non-smokers.
Collapse
Affiliation(s)
| | - Ali Tecirli
- Orthopedics and Traumatology Clinic Çankırı State Hospital, Çankırı, Turkey
| | - Çağrı Örs
- Orthopedics and Traumatology Clinic, Orthopedica Private Hospital, Adana, Turkey
| |
Collapse
|
10
|
Haghverdian JC, Hsu JWY, Harness NG. Complications of Corrective Osteotomies for Extra-Articular Distal Radius Malunion. J Hand Surg Am 2019; 44:987.e1-987.e9. [PMID: 30733100 DOI: 10.1016/j.jhsa.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/06/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteotomy of the distal radius for a fracture malunion is a challenging procedure. The purpose of this study was to review a series of osteotomies to determine the type and risk of complications. METHODS A retrospective cohort study was performed, including all Kaiser Permanente Southern California patients who were aged 18 years or older between January 1, 2007, and September 25, 2015, and underwent osteotomy for an extra-articular distal radius fracture malunion. Charts were reviewed for demographic data, comorbidities, osteotomy type (hinged vs distraction), implant, and bone graft type. Complications including infection, nonunion, loss of reduction, implant failure, nerve injury, tendon injury, and complex regional pain syndrome were recorded. RESULTS There were 60 patients who underwent extra-articular osteotomy of the distal radius for malunion during the study period. The mean age was 54 years (range, 21-83 years). There were 24 distraction-type (intervening bone graft) and 36 hinge-type (volar cortical contact maintained) osteotomies. Twenty-five of 60 patients had complications related to the procedure requiring 13 subsequent procedures. There were 7 nonunions and 3 cases of delayed healing at the osteotomy site. One extensor carpi radialis longus tendon laceration resulted from the use of an osteotome. There were 3 delayed extensor pollicis longus (EPL) tendon ruptures after surgery. The distraction-type osteotomy was associated with a greater risk of major complications including nonunion and delayed union. CONCLUSIONS A complication rate of nearly 50% was observed in distal radius osteotomies. Surgeons should be aware of the risk of injury to, or delayed rupture of the EPL tendon associated with these procedures. The risk of nonunion or delayed union is higher in distraction-type compared with hinge-type osteotomies. Low surgeon volume with this procedure may be a contributing factor to the high rate of complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Justin C Haghverdian
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Jin-Wen Y Hsu
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, CA
| | - Neil G Harness
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Anaheim, CA.
| |
Collapse
|
11
|
Shrouder-Henry J, Novak CB, Jackson T, Baltzer HL. Comparative Study of Early Health Care Use after Forearm Corrective Osteotomy. J Wrist Surg 2019; 8:139-142. [PMID: 30941254 PMCID: PMC6443397 DOI: 10.1055/s-0038-1677530] [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: 05/26/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Background Bone reconstruction is frequently required for corrective osteotomy of the forearm long bones. Studies have evaluated long term outcomes but not the impact of these procedures on early postoperative complications and health care utilization. Questions/Purposes This study evaluated the early postoperative health care utilization following corrective osteotomy of the radius and/or ulna. Patients and Methods The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) was the primary data source to perform a comparative statistical analysis of the bone autograft and nonautograft (allograft, graft substitute, or no graft) procedures. We performed a review of the NSQIP database (2005-2013) to evaluate patients who underwent a corrective osteotomy of the radius and/or ulna. Results There were 362 cases; autograft ( n = 117) and nonautograft ( n = 245). There were no significant differences with demographics or comorbidities. The majority of cases were outpatient surgeries and there were no significant differences in anesthesia time, operative time, or hospital length of stay. Overall, the average length of stay was 0.6 days, readmission rate was 2%, and the total complication rate was 1% and there was no statistically significant difference between reconstruction groups. Harvesting of autograft was not associated with the overall 30-day complications and specific markers of health care utilization. Conclusions Our results are derived from the heterogeneous hospital setting of NSQIP contributing centers. The health care utilization and 30-day complications are low following corrective osteotomy of forearm long bones and autograft harvest did not influence the health care utilization. Level of Evidence Therapeutic Level II.
Collapse
Affiliation(s)
- Jason Shrouder-Henry
- Department of Surgery, Toronto Western Hospital Hand Program, University of Toronto, Toronto, Ontario, Canada
| | - Christine B. Novak
- Department of Surgery, Toronto Western Hospital Hand Program, University of Toronto, Toronto, Ontario, Canada
| | - Timothy Jackson
- Department of Surgery, Toronto Western Hospital Hand Program, University of Toronto, Toronto, Ontario, Canada
| | - Heather L. Baltzer
- Department of Surgery, Toronto Western Hospital Hand Program, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Goto K, Naito K, Sugiyama Y, Kinoshita M, Nagura N, Kajihara H, Iwase Y, Kaneko K. Corrective Osteotomy with Autogenous Bone Graft with Callus after Malunion of Distal Radius Fracture. J Hand Surg Asian Pac Vol 2018; 23:571-576. [PMID: 30428805 DOI: 10.1142/s2424835518720323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Corrective osteotomy with callus filling at fracture site for malunion after distal radius fracture is a rare technique, but it achieved a favorable postoperative outcome. The patient, 66-year-old female, visited our hospital 4 months after distal radius fracture. Corrective osteotomy of the distal radius was planned aiming at improving the wrist joint function, and was performed using a volar locking plate, then the bone defect was filled with callus as autogenous bone grafting. At 12 months after surgery, left wrist joint pain and the range of motion have improved, and the Mayo wrist score was excellent. To our knowledge, there has been no study on the treatment of bone defects by filling with callus. Since favorable bone fusion was achieved with callus, this treatment method may overcome the disadvantages of autogenous bone graft, such as pain at the donor region.
Collapse
Affiliation(s)
- Kenji Goto
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan.,† Department of Orthopaedic Surgery, Koto Hospital, Tokyo, Japan
| | - Kiyohito Naito
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Yoichi Sugiyama
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Mayuko Kinoshita
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Nana Nagura
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Hajime Kajihara
- † Department of Orthopaedic Surgery, Koto Hospital, Tokyo, Japan
| | - Yoshiyuki Iwase
- ‡ Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kazuo Kaneko
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| |
Collapse
|
13
|
Mulders MAM, d'Ailly PN, Cleffken BI, Schep NWL. Corrective osteotomy is an effective method of treating distal radius malunions with good long-term functional results. Injury 2017; 48:731-737. [PMID: 28179058 DOI: 10.1016/j.injury.2017.01.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Malunion occurs in approximately 23% of non-operatively treated and 11% of operatively treated distal radius fractures. The decision whether to correct a malunion is primarily based on functional impairment and wrist pain. The purpose of this study was to assess the long-term functional outcomes of corrective osteotomies for symptomatic malunited distal radius fractures. METHODS All consecutive corrective osteotomies of the distal radius performed in one centre between January 2009 and January 2016 were included. The primary outcome was the functional outcome assessed with the Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes were range of motion, grip strength, pain as indicated on the Visual Analogue Scale (VAS) before and after corrective osteotomy, radiological parameters, time to union and complications. Additionally, we aimed to determine if there were any difference in graft versus no graft usage. RESULTS A total of 48 patients were included. The median age was 54.5 years (IQR 39-66) and 71% was female. The median time to follow-up was 27 months. The median DASH and PRWE score were respectively 10.0 (IQR 5.8-23.3) and 18.5. (6.5-37.0). Except for pronation and supination, range of motion and grip strength of the injured wrist were significantly less compared to the uninjured side. Palmar and dorsal flexion and radial and ulnar deviation of the injured wrist were significantly less compared with the uninjured side. VAS pain scores decreased significantly from 6.5 preoperative to 1.0 postoperative. The median time to union was 23 weeks (IQR 12-29.5). Eighteen patients (38%) had a complication for which additional treatment was required. Except for a significant difference in radial inclination and length after the corrective osteotomy in favour of graft usage, there were no significant differences between graft an no graft usage. CONCLUSIONS Corrective osteotomy is an effective method of treating symptomatic distal radius malunions with good long-term functional results, measured with the DASH and PRWE score, and improvement in radiographic parameters and pain scores. Additionally, no differences in functional outcomes were found between graft and no graft usage.
Collapse
Affiliation(s)
- M A M Mulders
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - P N d'Ailly
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| |
Collapse
|
14
|
Mugnai R, Tarallo L, Lancellotti E, Zambianchi F, Di Giovine E, Catani F, Adani R. Corrective osteotomies of the radius: Grafting or not? World J Orthop 2016; 7:128-135. [PMID: 26925385 PMCID: PMC4757658 DOI: 10.5312/wjo.v7.i2.128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/03/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting.
METHODS: Our MEDLINE literature search included 280 studies using the following key words “Malunited distal radius fracture” and 150 studies using key words “Corrective osteotomy of the distal radius”. Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria.
RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn’t use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft.
CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft.
Collapse
|
15
|
Fok MWM, Fernandez DL, Rivera YLH. A less invasive distal osteotomy of the radius for malunited dorsally displaced extra-articular fractures. J Hand Surg Eur Vol 2015; 40:812-8. [PMID: 25261410 DOI: 10.1177/1753193414551910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/21/2014] [Indexed: 02/03/2023]
Abstract
A less invasive corrective osteotomy for symptomatic post-traumatic deformity of the distal radius was done in 12 patients. They were followed up for an average of 3.7 years. The indications for correction were based on the patients' level of activities, pain, functional limitations, loss of grip strength or deformity occurring with an extra-articular rotational malunion of the distal end of the radius. The procedure included a dorsal open wedge osteotomy through a dorsal incision in which the fulcrum of rotation, or hinge, was located at the palmar cortex, and stabilized with an extra- and intramedullary fixed angle device. The bone defect was replaced with autologous morsellized iliac bone graft. The final outcome was graded as very good in eight patients, good in two and fair in two. Level of evidence: IV.
Collapse
Affiliation(s)
- M W M Fok
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
| | - D L Fernandez
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
| | | |
Collapse
|
16
|
Disseldorp DJG, Poeze M, Hannemann PFW, Brink PRG. Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures? J Wrist Surg 2015; 4:207-213. [PMID: 26261748 PMCID: PMC4530180 DOI: 10.1055/s-0035-1558831] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. However, bone grafts are also associated with donor site morbidity, delayed union at bone-graft interfaces, size mismatch between graft and osteotomy defect, and additional operation time. Purpose The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Methods Between January 1993 and December 2013, 132 corrective osteotomies and plate fixations without bone grafting were performed for malunited distal radius fractures. The minimum follow-up time was 12 months. Primary study outcomes were time to complete bone healing and secondary fracture displacement. Preoperative and postoperative radiographs during follow-up were compared with each other, as well as with radiographs of the uninjured side. Results All 132 osteotomies healed. In two cases (1.5%), healing took more than 4 months, but reinterventions were not necessary. No cases of secondary fracture displacement or hardware failure were observed. Significant improvements in all radiographic parameters were shown after corrective osteotomy and plate fixation. Conclusion This study shows that bone grafts are not required for bone healing and prevention of secondary fracture displacement after corrective osteotomy and plate fixation of malunited distal radius fractures. Level of evidence Therapeutic, level IV, case series with no comparison group.
Collapse
Affiliation(s)
- Dominique J. G. Disseldorp
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter R. G. Brink
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
17
|
Tiren D, Vos DI. Correction osteotomy of distal radius malunion stabilised with dorsal locking plates without grafting. Strategies Trauma Limb Reconstr 2014; 9:53-8. [PMID: 24610600 PMCID: PMC3951621 DOI: 10.1007/s11751-014-0190-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/02/2014] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to evaluate the results of our correction osteotomies of distal radial malunions without a bone graft. Eleven consecutive patients (mean age 52 years, range 18–71) were treated. A dorsal approach was utilised to perform an opening-wedge osteotomy which then was stabilised with two dorsal columnar plates without filling the osteotomy gap. All patients went on to radiographic union with a filling of the osteotomy gap within a mean period of 3 months (range 2–6 months). All patients had satisfactory results in terms of function and pain. Correction osteotomy and stabilisation with bicolumnar locked plate fixation without a bone graft provides sufficient stability to allow the highly vascularised metaphysis to heal. In patients without risk factors predisposing to non-union, this procedure is safe and feasible.
Collapse
Affiliation(s)
- D Tiren
- Department of General and Trauma Surgery, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands,
| | | |
Collapse
|
18
|
Sabharwal S, Fragomen A, Iobst C. What's new in limb lengthening and deformity correction. J Bone Joint Surg Am 2013; 95:1527-34. [PMID: 23965706 DOI: 10.2106/jbjs.m.00599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA.
| | | | | |
Collapse
|
19
|
Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement to assess reporting of observational trials in hand surgery. J Hand Surg Am 2013; 38:1584-9.e2. [PMID: 23845586 PMCID: PMC3989883 DOI: 10.1016/j.jhsa.2013.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To use the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist to critically evaluate the change in quality of observational trial reporting in the Journal of Hand Surgery American between 2005 and 2011. METHODS A cross-sectional analysis of observational studies published in the Journal of Hand Surgery American was designed to sample 2 6-month periods of publication (March 2005 to August 2005 and June 2011 to November 2011). Fifty-one items were extracted from the STROBE statement for evaluation. Overall STROBE compliance rates for articles and specific checklist items were determined. Final compliance percentages from each period were compared by Student t-testing. Changes in item compliance over time were quantified. RESULTS Overall compliance with the STROBE statement was 38% (range, 10%-54%) in 2005 and 58% (range, 39%-85%) for 2011 manuscripts representing a significant improvement. Seventy-five percent or greater of articles (2005/2011) provided the explicit reporting of background (100%/97%), follow-up time (85%/94%), overall interpretation of data (100%/94%), and results of similar studies (95%/89%). Twenty-five percent or less of articles provided the study design in the abstract (10%/20%), a clear description of the study's setting (10%/23%), the handling of missing data (0%/6%), the potential directions of bias (5%/11%), and the use of a power analysis (0%/17%). Eighty-six percent (44/51) of items were more frequently satisfied in 2011 articles than in 2005 publications. Absolute increases in compliance rates of 40% or greater were noted in 10 items (20%) with no worsening in compliance for an individual item over 6%. CONCLUSIONS The overall quality of the reporting of observational trials in the Journal of Hand Surgery American improved from 2005 to 2011. Current observational trials in hand surgery could still benefit from increased reporting of methodological details including the use of power analyses, the handling of missing data, and consideration of potential bias. LEVEL OF EVIDENCE Diagnostic III.
Collapse
|
20
|
Vorrapakdee R, Kanokpanont S, Ratanavaraporn J, Waikakul S, Charoenlap C, Damrongsakkul S. Modification of human cancellous bone using Thai silk fibroin and gelatin for enhanced osteoconductive potential. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:735-744. [PMID: 23224853 DOI: 10.1007/s10856-012-4830-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
The modification of human cancellous bone (hBONE) with silk fibroin/gelatin (SF/G) using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC)/N-hydroxysuccini-mide (NHS) crosslinking was established. The SF/G solutions at a weight ratio of 50/50 and the solution concentrations of 1, 2, and 4 wt % were studied. SF/G sub-matrix was formed on the surface and inside pore structure of hBONE. All hBONE scaffolds modified with SF/G showed smaller pore sizes, less porosity, and slightly lower compressive modulus than unmodified hBONE. SF/G sub-matrix was gradually biodegraded in collagenase solution along 4 days. The hBONE scaffolds modified with SF/G, particularly at 2 and 4 wt % solution concentrations, promoted attachment, proliferation, and osteogenic differentiation of bone marrow-derived mesenchymal stem cells (MSC), comparing to the original hBONE. The highest cell number, ALP activity and calcium production were observed for MSC cultured on the hBONE scaffolds modified with 4 wt % SF/G. The mineralization was also remarkably induced in the cases of modified hBONE scaffolds as observed from the deposited calcium phosphate by EDS. The modification of hBONE with SF/G was, therefore, the promising method to enhance the osteoconductive potential of human bone graft for bone tissue engineering.
Collapse
Affiliation(s)
- Rungnapa Vorrapakdee
- Department of Chemical Engineering, Faculty of Engineering, Chulalongkorn University, Phatumwan, Bangkok, Thailand
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
The interest in developing biomaterials to augment fracture healing continues to grow. New products promise early return to function with minimal morbidity; however, indications to use these products remain unclear. An ideal bone graft material stimulates bone healing and provides structural stability while being biocompatible, bioresorbable, easy to use, and cost-effective. This article reviews the biology of bone grafts and the clinical evidence in the use of bone graft substitutes for the treatment of distal radius fractures.
Collapse
Affiliation(s)
- Kagan Ozer
- Department of Orthopaedic Surgery, University of Michigan Health System, 2098 South Main Street, Ann Arbor, MI 48103, USA.
| | | |
Collapse
|