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Teunissen JS, Al Shaer S, van der Heijden BP, Selles RW, Hovius SE, Zöphel OT. The association between plate location and hardware removal following ulna shortening osteotomy: a cohort study. J Hand Surg Eur Vol 2022; 47:831-838. [PMID: 35410539 PMCID: PMC9459407 DOI: 10.1177/17531934221089228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hardware removal after ulna shortening osteotomy is common. We evaluated the association between plate location and hardware removal rate in 326 procedures in 321 patients with a median follow-up of 4.3 years (IQR 3.3) and corrected for confounding variables and did survival analyses. Complications were scored using the International Consortium for Health Outcome Measurement complications in Hand and Wrist Conditions tool. The 1-year and 5-year reoperation rates for hardware removal were 21% and 46% in the anterior group versus 37% and 64% in the dorsal group. Anterior plate placement was independently associated with a decreased immediate risk of hardware removal. Higher age, male sex and treatment on the dominant side were also associated with a reduced risk of hardware removal. We did not find a difference in hardware removal rates between freehand or jig-guided ulna shortening osteotomies. We noted perioperative problems in 3% of the procedures and complications in 20%.Level of evidence: III.
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Affiliation(s)
- Joris S. Teunissen
- Department of Plastic, Reconstructive and
Hand Surgery, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The
Netherlands,Hand and Wrist Center, Xpert Clinics,
Amsterdam, The Netherlands,Joris S. Teunissen, Plastic, Reconstructive and
Hand Surgery, Radboud University Medical Centre; Geert Grooteplein Zuid 10, 6525 GA
Nijmegen, The Netherlands.
| | - Sanharib Al Shaer
- Hand and Wrist Center, Xpert Clinics,
Amsterdam, The Netherlands,Department of Surgery, Medisch Spectrum
Twente, Enschede, The Netherlands
| | - Brigitte P.A. van der Heijden
- Department of Plastic, Reconstructive and
Hand Surgery, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The
Netherlands,Department of Plastic, Reconstructive and
Hand Surgery, Jeroen Bosch Ziekenhuis,’s-Hertogenbosch, Brabant, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and
Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Steven E.R. Hovius
- Department of Plastic, Reconstructive and
Hand Surgery, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The
Netherlands,Hand and Wrist Center, Xpert Clinics,
Amsterdam, The Netherlands
| | - Oliver T. Zöphel
- Hand and Wrist Center, Xpert Clinics,
Amsterdam, The Netherlands,Department of Plastic, Reconstructive and
Hand Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
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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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Samade R, Farrell N, Zaki O, Farrar N, Goyal KS. Outcomes following Distal Radius Fractures with Preexisting Ulnocarpal Abutment. J Wrist Surg 2021; 10:329-334. [PMID: 34381637 PMCID: PMC8328551 DOI: 10.1055/s-0041-1726294] [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: 05/21/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Background Due to the commonality of distal radius fractures (DRFs), the potential impact of ulnocarpal abutment (UA) on patient outcomes is significant, whether it developed after or prior to injury. It is, therefore, important to consider whether preexisting UA has any impact on outcomes after an acute DRF. Questions/Purpose The aims of this study were to determine if differences were present in (1) pain at final follow-up, (2) complications, and (3) unintended operations in patients with DRFs and either without or with preexisting radiographic UA. Methods A single institution retrospective cohort study comparing patients treated either nonoperatively (43 patients) or operatively (473 patients) for DRFs between 5/1/2008 to 5/1/2018 was performed. Data included demographics, prior wrist pain or surgery, ulnar variance, select treatment data, and presence of pain, complication, or unintended operation by final follow-up. Statistical testing used Fisher's exact test and chi-squared test, with a significance level of 0.05. Results The prevalence of preexisting UA was 14.0 and 15.6% in the nonoperatively- and operatively treated groups, respectively. In nonoperatively treated patients without or with UA, no differences in pain (37.8 vs. 33.3%, p = 1.00) or complications were seen (13.5 vs. 50.0%, p = 0.07). A higher unintended operation rate for nonoperatively treated DRFs with UA, compared with those without, UA was seen (5.4 vs. 50.0%, p = 0.01). No differences in pain, complications, or unintended operations were seen between those without and with UA in the operatively treated group. Conclusion Preexisting UA is not associated with pain, complications, or unintended operations after operative treatment of DRFs. Prospective studies further evaluating outcomes in nonoperatively treated DRFs with UA may be beneficial.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nolan Farrell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Omar Zaki
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicholas Farrar
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kanu S. Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Iwatsuki K, Yoneda H, Onishi T, Ishii H, Kurimoto S, Yamamoto M, Tatebe M, Hirata H. Compatibility of magnetic resonance imaging in patients with orthopedic implants: manufacturer questionnaires. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:79-84. [PMID: 32273635 PMCID: PMC7103874 DOI: 10.18999/nagjms.82.1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In clinical practice, surgeons have stated that magnetic resonance imaging (MRI) can be performed in patients with titanium alloy implants. However, manufacturers and distributors of many implants may not comply with this common practice. As such, this study aimed to investigate manufacturers’ views on MRI use in patients fitted with their implants. The questionnaire survey was conducted between May and August 2018. Is your product compatible with MRI? ( ) Select from (1) to (3). In case of (1) or (2), up to ( ) Tesla. (1) MRI can be performed even at the sites of implanted fixators. (2) MRI can be performed at sites without implanted fixators. (3) MRI cannot be performed, or the manufacturer does not approve MRI use (cannot issue a certificate). The questionnaire forms were sent to 12 manufacturers, and the response rate was 100%. Manufacturers responded that they could not publicly allow MRI use in patients with their products. These findings do not conclude that MRI cannot be performed in such patients. This survey revealed that currently decisions regarding MRI use is left to the treating physicians. This situation poses a great problem for medical safety and imposes a substantial burden on physicians. As many problems remain in the field of orthopedic surgery, manufacturers of implants should proactively manage issues surrounding the usage of MRI.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Onishi
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisao Ishii
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Tatebe
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Iwatsuki K, Yoneda H, Kurimoto S, Yamamoto M, Tatebe M, Hirata H. Osteoid osteoma of the wrist misdiagnosed as de Quervain's tenosynovitis due to normal X-ray at the first visit: A case report. Int J Surg Case Rep 2020; 75:469-472. [PMID: 33076197 PMCID: PMC7527622 DOI: 10.1016/j.ijscr.2020.09.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Osteoid osteomas are benign bone tumors that can occur in various bones throughout the body but are mainly found in the long bones. PRESENTATION OF THE CASE We report the case of a patient who had been treated for more than three years for a case of de Quervain's tenosynovitis due to tenderness in the first compartment of the right wrist joint. An X-ray on his first visit to a clinic was normal, but it was eventually discovered that he had an osteoid osteoma of the wrist. DISCUSSION The age of onset and gender proclivity of each disease should be considered. An X-ray should be taken in cases such as this, even to diagnose tendonitis. When any symptom, such as pain, has lingered for a long time and resisted treatment, we must reconsider the diagnosis. In patients with a low risk of tendonitis, it is essential to consider the possibility of other diseases if there is no improvement after treatment. As this patient's tumor was missed on the initial X-ray, it grew to a mature case of osteoid osteoma in three years. CONCLUSION We experienced a very educational case of osteoid osteoma of the wrist misdiagnosed as de Quervain's tenosynovitis.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan.
| | - Hidemasa Yoneda
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Masahiro Tatebe
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
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Abstract
Injuries to the scapholunate (SL) and lunotriquetral (LT) interosseous ligaments occur in approximately one third of distal radius fractures. The diagnosis of these injuries is challenging because plain radiographs are not reliably diagnostic. Wrist arthroscopy may be the most accurate way to examine and diagnose soft-tissue injuries of the carpus adjacent to a distal radius fracture. Treatment options for SL and LT ligament injuries include open repair and/or percutaneous pinning. Because the natural history of these injuries is unclear, the necessity of diagnosing and treating these SL and LT interosseous ligament defects remains speculative.
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Owens J, Compton J, Day M, Glass N, Lawler E. Nonunion Rates Among Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome: A Systematic Review. J Hand Surg Am 2019; 44:612.e1-612.e12. [PMID: 30342784 DOI: 10.1016/j.jhsa.2018.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/06/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to systematically review all available literature reporting nonunion rates of ulnar-shortening osteotomies (USO) used for the treatment of ulnar impaction syndrome (UIS) and to compare those rates among transverse versus oblique cuts for the osteotomy. METHODS Electronic databases including PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for studies that evaluated outcomes of both transverse and oblique USO for UIS. Level of evidence was determined by 2 independent reviewers. Studies were screened based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and inclusion and exclusion criteria were applied. A total of 37 studies (1,423 patients) were included in final analysis. The average rate of nonunion and delayed union for each group (transverse and oblique osteotomy) was calculated. RESULTS The average rate of nonunion among all osteotomies was 4.0%. The average rate of nonunion was 4.16% and 3.86% in transverse osteotomies and oblique osteotomies, respectively. This difference was not statistically significant. The average rate of delayed union, in those studies that reported delayed union, was 5.7%. The average rate of delayed union was 7.41% and 4.1% in transverse osteotomies and oblique osteotomies, respectively. CONCLUSIONS Based on our review of the literature, there is no difference in the rate of nonunion between transverse and oblique osteotomies. Therefore, the decision of which of the 2 surgical techniques should not be based on rate of nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jessell Owens
- Orthopedics Department, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Jocelyn Compton
- Orthopedics Department, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Molly Day
- Orthopedics Department, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Natalie Glass
- Orthopedics Department, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Ericka Lawler
- Orthopedics Department, University of Iowa Hospitals and Clinics, Iowa City, IA
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Abstract
Both ulnocarpal impaction syndrome and ulnar styloid impaction syndrome can produce ulnar wrist pain. The definition and clinical differentiation are explained. The relevant anatomy, biomechanics, causes, diagnosis, and arthroscopic treatments, as well as the surgical indications, techniques, and outcomes of these syndromes are discussed in detail.
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Affiliation(s)
- David J Slutsky
- Department of Orthopedics, Harbor UCLA Medical Center, Torrance, CA 90503, USA; The Hand and Wrist Institute, 2808 Columbia Street, Torrance, CA 90503, USA.
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Lim JW, Lee YB, Lee JS. Late radio-lunate arthritis following ulnar shortening osteotomy. J Orthop Sci 2017; 22:1142-1145. [PMID: 27192926 DOI: 10.1016/j.jos.2016.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 02/09/2023]
Affiliation(s)
- Jung-Won Lim
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, School of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea
| | - Yong Beom Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 431-796, South Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, School of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea.
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Abstract
Determining the etiology of ulnar-sided wrist pain is often challenging. The condition may be acute or chronic, and differential diagnoses include injuries to the ulnar carpal bones, ligament tears, tendinitis, vascular conditions, osteoarthritis and systemic arthritis, and ulnar nerve compression. An anatomically based, methodical physical examination coupled with provocative maneuvers, including piano key, ulnar impaction, shuck, foveal stress, and extensor carpi ulnaris synergy tests, further defines the differential diagnosis. Diagnostic imaging used in the evaluation of ulnar-sided wrist pain includes plain radiographs and MRI with or without arthrography. Wrist arthroscopy is becoming increasingly important in the diagnosis and management of ulnar-sided intra-articular wrist pathology.
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Gaspar MP, Kane PM, Zohn RC, Buckley T, Jacoby SM, Shin EK. Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate. J Hand Surg Am 2016; 41:237-43.e1-2. [PMID: 26686063 DOI: 10.1016/j.jhsa.2015.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system. METHODS We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed. Time to bony union was determined radiographically by a blinded reviewer. Bivariate statistical analysis was performed to examine the effect of explanatory variables on the time to union and the incidence of delayed or nonunion. Those variables associated with the development of delayed or nonunion were used in a multivariate logistic regression model. Complications, including the need for additional surgery, were also recorded. RESULTS Seventy-two ulnar shortening osteotomy procedures were performed in 69 patients. Delayed union, defined as ≥ 6 months to union, occurred in 8 of 72 cases (11%). Of 72 surgeries, 4 (6%) resulted in nonunions, all of which required additional surgery. Hardware removal was performed in 13 of 72 (18%) of the cases. Time to union was significantly increased in smokers (6 ± 3 months) versus nonsmokers (3 ± 1 months). On multivariable analysis, diabetics and active smokers demonstrated a significantly higher risk of developing delayed union or nonunion. Patient age, sex, body mass index, thyroid disease, worker's compensation status, alcohol use, and amount smoked daily did not have an effect on the time to union or the incidence of delayed or nonunion. CONCLUSIONS Despite the use of an osteotomy-specific plating system, smokers and diabetics were at significantly higher risk for both delayed union and nonunion following elective ulnar shortening osteotomy. Other known risk factors for suboptimal bony healing were not found to have a deleterious effect.
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Affiliation(s)
- Michael P Gaspar
- The Philadelphia Hand Center, P.C., Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Patrick M Kane
- The Philadelphia Hand Center, P.C., Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ralph C Zohn
- The Philadelphia Hand Center, P.C., Philadelphia, PA
| | | | - Sidney M Jacoby
- The Philadelphia Hand Center, P.C., Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Eon K Shin
- The Philadelphia Hand Center, P.C., Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
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