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Cha SM, Pai A, Lee HJ, Shin HD. Non-vascularised corticocancellous (tricortical) iliac bone graft longer than 3 cm for non-union after failed surgical treatment. J Plast Reconstr Aesthet Surg 2024; 88:37-44. [PMID: 37950990 DOI: 10.1016/j.bjps.2023.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/03/2023] [Accepted: 10/07/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE We hypothesised that traditional iliac tricortical bone grafts (no vascularised) still have a reasonable role in promoting satisfactory bony healing in non-union defects of certain sizes. Here, we report the clinical/radiological outcomes through a retrospective case series. METHODS We screened 74 patients with definitive non-union in the long bones of the upper extremities who visited the outpatient department from 2008 to 2018. Among these patients, 25 who met our inclusion/exclusion criteria were investigated. RESULTS The mean age was 51.92 years, and there were 12, 9, 1, and 3 lesions of the radius, ulna, clavicle, and humerus, respectively. The tools for primary fixations were plate and intramedullary nails in 24 and 1 patients, respectively. Six patients presented with atrophic non-union. The mean period from a previous surgery was 6.84 months. The mean defective bone sizes were 1.81 and 3.50 cm pre-debridement and post-debridement, respectively. All devices had locking plates longer than the previous plate, and the graft was concurrently fixed by screws in three patients. At a mean of 15.92 weeks after the revision surgery, all patients experienced union. At the final follow-up, the clinical outcomes were satisfactory. No significant differences in clinical outcomes were found according to the lesion, type of non-union, period from the previous surgery, or harvest length of the iliac bone. CONCLUSIONS If the proper indications and some technical aspects are considered, a non-vascularised iliac bone graft longer than 3 cm could still be a reasonable option for treating diaphyseal non-union of the upper extremities. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Centre, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Ashwin Pai
- Department of Plastic Surgery, West Suffolk NHS Foundation Trust, United Kingdom
| | - Hyun Jong Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Centre, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Centre, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
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Deng HL, Lu ML, Tang ZM, Mao QL, Zhao JM. Is metaphyseal ulnar shortening osteotomy superior to diaphyseal ulnar shortening osteotomy in the treatment of ulnar impaction syndrome? A meta-analysis. World J Clin Cases 2023; 11:2753-2765. [PMID: 37214579 PMCID: PMC10198107 DOI: 10.12998/wjcc.v11.i12.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Although metaphyseal ulnar shortening osteotomy (MUSO) is safer for the treatment of ulnar impaction syndrome (UIS) than diaphyseal ulnar shortening osteotomy (DUSO), DUSO is widely used for UIS treatment.
AIM To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.
METHODS Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE (Ovid), PubMed, EMBASE, and Cochrane Library. The demography, incidence of complications, secondary operation rate, postoperative DASH score, wrist pain on the visual analogue scale, and grip strength improvement were also evaluated. In addition, the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed. The outcome of the patient was discontinuous, and the odds ratio, risk ratio (RR), and 95%CI were calculated and analyzed via RevMan5.3 software.
RESULTS Six studies, including 83 patients receiving MUSO (experimental group) and 112 patients receiving DUSO (control group), were included in the meta-analysis. The second operation rate was significantly higher after DUSO than after MUSO. The DASH scores were slightly lower in the MUSO group than in the DUSO group. The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO. However, the incidence of complications and improvement of grip strength were not significantly different between the two groups.
CONCLUSION Although DUSO and MUSO provide similar effects for UIS, MUSO is associated with a lower secondary operation rate, slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO, indicating that MUSO can effectively be used for UIS treatment.
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Affiliation(s)
- Hai-Lin Deng
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ming-Ling Lu
- Ministry of Public Health, Department of Public Health Unit, Liuzhou Liunan District Center for Disease Control, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
| | - Zhe-Ming Tang
- Department of Hand, Foot and Ankle Surgery, Liuzhou Workers' Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
| | - Qing-Long Mao
- Department of Hand, Foot and Ankle Surgery, Liuzhou Workers' Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
| | - Jin-Min Zhao
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Zadel N, Jourdel F, Goulon R, Latrobe C, Neri T. Is intramedullary pinning for isolated ulnar shaft fractures a surgical alternative to plate fixation? Orthop Traumatol Surg Res 2023; 109:103507. [PMID: 36503084 DOI: 10.1016/j.otsr.2022.103507] [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: 04/22/2021] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Unstable isolated ulnar shaft fractures are rare injuries that need to be surgically treated. The purpose of this study was to compare the functional and radiographic outcomes of two types of surgeries: closed reduction and intramedullary fixation (IMF) by pinning and open reduction and internal fixation (ORIF). HYPOTHESIS Our hypothesis was that IMF obtained similar outcomes to ORIF. MATERIALS AND METHODS All patients treated for an isolated distal or middle third ulnar shaft fracture between 2016 and 2019 were enrolled into two groups: ORIF and IMF. The technique performed depended on the surgeon's preference and not the type of fracture or patient. Demographic and clinical data (QuickDASH) and complications were retrospectively collected. X-rays were also examined to classify the fracture, assess postoperative reduction quality, and determine the amount of shortening and angulation. RESULTS A total of 81 patients with a mean age of 34 years were divided into two groups: 34 in ORIF and 47 in IMF. The two groups had similar demographics, mechanisms of injury, and preoperative fracture characteristics. The only difference was smoking (p<0.001). Despite a greater mean ulnar shortening of 0.4 mm in the IMF group (p=0.048), there were no significant differences regarding the functional score (QuickDASH) and rate of pseudarthrosis. However, the operative time (p<0.001) was shorter in the IMF group. DISCUSSION In the treatment of unstable isolated ulnar shaft fractures, IMF and ORIF had similar clinical and radiographic outcomes in terms of bone healing. The mean ulnar shortening reported in the IMF group was small and was not at risk of developing posttraumatic osteoarthritis. CONCLUSION IMF is a feasible therapeutic alternative to ORIF for isolated fractures of the distal two-thirds of the ulnar shaft. Further studies with a higher level of evidence need to be conducted to confirm the equivalence of these two fixation techniques. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Nicolas Zadel
- Service de chirurgie orthopédique et traumatologique, centre hospitalier territorial de Nouméa, Nouvelle-Calédonie, France.
| | - François Jourdel
- Service de chirurgie orthopédique et traumatologique, centre hospitalier territorial de Nouméa, Nouvelle-Calédonie, France
| | - Renaud Goulon
- Service de chirurgie orthopédique et traumatologique, centre hospitalier territorial de Nouméa, Nouvelle-Calédonie, France
| | - Charles Latrobe
- Service de chirurgie orthopédique et traumatologique, centre hospitalier territorial de Nouméa, Nouvelle-Calédonie, France
| | - Thomas Neri
- Chirurgie orthopédique et traumatologie, centre hospitalier et universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France; Laboratoire de physiologie de l'exercice, EA 4338, Saint-Étienne, France
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Cha SM, Shin HD, Kim YK, Lee KW. Ulnar shortening osteotomy for posttraumatic ulnar impaction syndrome in adolescent (younger than 18 years) - Based on the Cha & Shin assessment. Injury 2022; 53:4038-4047. [PMID: 36243581 DOI: 10.1016/j.injury.2022.10.004] [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: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We performed ordinary ulnar shortening osteotomy (USO) in patients younger than 18 years old with secondary ulnar impaction syndrome (UIS) after traumatic events. Here, we report the clinical and radiologic outcomes with a review of the previous literature through a retrospective case series. METHODS Twenty-two adolescents treated by USOs from 2006 to 2018 were investigated. The amount of shortening was classified into three categories. The first category was for a still open physis on the medial half of the radius in those younger than 15. In this category, we osteotomized the ulna for the physis level to be left neutral or negative by 1-2 mm. The second category had no growth potency in the radius. If the patient was younger than 15, we considered only residual growth of the ulna, thus performing USO for the ordinary UV to be negative by 2-3 mm. For patients aged 15-18 years old, if growth potency was nearly absent in the ulna, we performed traditional USO with a neutral ulnar variance (UV). RESULTS Categories 1, 2, and 3 for the amount of USO were determined for 4, 4, and 14 patients, respectively. All USOs properly healed without substantial complications. The mean preoperative UV was 2.91 mm, and the final value decreased to 0.23 with statistical significance (p < 0.001). The range of wrist motion was improved after USO from 133.86° and 132.73° to 154.77° and 160.68° (all, p < 0.001 in flexion-extension and pronation-supination arcs, respectively). The preoperative VAS and MMWS scores also improved from 2.77 to 75.00 to 0.18 and 88.86, respectively, at the final follow-up (all, p < 0.001). CONCLUSIONS UIS in adolescent populations after trauma in their children/younger adolescents could be properly treated by USO. Even with an open physis at the ulna, neutral UVs could be achieved, and the clinical outcomes were satisfactory. However, long-term follow-up is still needed regarding TFCC and DRUJ status. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
| | - Yun Ki Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kun Woo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Wang J, Yin Y, Sun C, Wu R, Luo T, Che J, Bu J. The association of three anatomical factors with ulnar-sided wrist pain: a radiological study. Acta Radiol 2022; 64:250-256. [PMID: 35108123 DOI: 10.1177/02841851221076331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ulnar-sided wrist pain is associated with the development of multiple wrist pathologies. But the anatomical etiologies have not been fully understood. PURPOSE To determine the association of three anatomical factors with ulnar-sided wrist pain, including ulnar variance (UV), distal ulnar volar angle (DUVA), and pisiform-ulnar distance (PUD). MATERIAL AND METHODS A total of 64 patients who had ulnar-sided wrist pain associated with training injuries were retrospectively studied. A control group included 64 healthy athletes from the same unit. The UV, DUVA, and PUD of each individual was measured on radiographs. RESULTS The average UV and DUVA of those in the ulnar-sided pain group were 0.84 mm and 174.65°, respectively; the control group values were 0.39 mm and 175.11°. The differences between the two groups had no statistical significance (P > 0.05). The average PUD of the ulnar-sided wrist pain group was shorter than that of the control group (2.37 cm vs. 2.65 cm); the difference had statistical significance (P < 0.05). PUD had a negative correlation with ulnar-sided pain; it was an anatomical protective factor (odds ratio = 0.01; P < 0.00; 95% confidence interval=0.00-0.05). Both UV and DUVA had no significant correlations with ulnar-sided wrist pain (P > 0.05). CONCLUSION PUD has a significant correlation with ulnar-sided wrist pain. It is the anatomical protective factor. Both the UV and DUVA have no statistical association with ulnar-sided wrist pain, but we cannot ignore their potential pathogenic effects on wrists, and further studies are needed to confirm the results.
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Affiliation(s)
- Jiangtao Wang
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Yu Yin
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Cheng Sun
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Ruimin Wu
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Tao Luo
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Jianwei Che
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
| | - Jianli Bu
- Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, PR China
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Kim J, Cho J, Lee YH, Oh S, Gong HS, Baek GH. Distal radioulnar joint configurations in three-dimensional computed tomography in patients with idiopathic ulnar impaction syndrome. J Hand Surg Eur Vol 2019; 44:488-495. [PMID: 30799668 DOI: 10.1177/1753193419828330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 26 patients diagnosed with idiopathic ulnar impaction syndrome and measured the slopes of the sigmoid notch and ulnar head at their centre using their preoperative three-dimensional computed tomography. We found that the slope of the sigmoid notch and that of the ulnar head were not parallel to each other. There was a significant linear relation between the slope of the ulnar head and the changes in the closest joint space of the distal radioulnar joint at the centre of the sigmoid notch after ulnar shortening. We conclude that the slope of the ulnar head is more strongly correlated with changes in the closest joint space in the distal radioulnar joint than that of the sigmoid notch. Our findings suggest that slope of the ulnar head might be as important a predisposing factor as that of the sigmoid notch for the progression of distal radioulnar joint arthritis after ulnar-shortening osteotomy. We should consider the slopes of both the sigmoid notch and ulnar head before the osteotomy. Level of evidence: IV.
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Affiliation(s)
- Jihyeung Kim
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Jaewoo Cho
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Yo-Han Lee
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
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