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Liu Y, Li X, Su X, Yin H, Xu W, Shen Y. A modified partial wedge-shaped metaphyseal ulnar osteotomy for the treatment of ulnar impaction syndrome with reverse oblique sigmoid notch. J Hand Surg Eur Vol 2024:17531934241252302. [PMID: 38780140 DOI: 10.1177/17531934241252302] [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] [Indexed: 05/25/2024]
Abstract
We describe a modified metaphyseal ulnar osteotomy to treat ulnar impaction syndrome with a reverse oblique sigmoid notch. Based on a computational analysis of radiographs, a modified wedge metaphyseal ulnar osteotomy was devised with its apex positioned at the ulnar styloid base to avoid impaction between the sigmoid notch and ulnar head. Subsequently, nine patients with ulnar impaction syndrome and a reverse oblique sigmoid notch underwent this operation, combined with arthroscopic exploration and transosseous triangular fibrocartilage complex repair. The mean follow-up was 14 months. All patients achieved bone union within 5 weeks, with no degenerative changes being observed during the follow-up assessments. The final follow-up assessments revealed decreases in ulnar variance and in the scores for Visual Analogue Scale, Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Patient-Rated Wrist Evaluation. All patients achieved excellent or good grades on the Modified Mayo Wrist Score. This technique is effective in treating the ulnar impaction syndrome with a reverse oblique sigmoid notch.Level of evidence: IV.
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Affiliation(s)
- Yuchen Liu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, People's Republic of China
| | - Xiucun Li
- Department of Hand and Foot Surgery, The Second Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Xiangmeng Su
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, People's Republic of China
| | - Huawei Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hand Reconstruction, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
- Institute of Hand Surgery, Fudan University, Shanghai, People's Republic of China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hand Reconstruction, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
- Institute of Hand Surgery, Fudan University, Shanghai, People's Republic of China
| | - Yundong Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hand Reconstruction, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
- Institute of Hand Surgery, Fudan University, Shanghai, People's Republic of China
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Daoulas T, Bernard M, Dellestable A, Letissier H, Bacle G, Sos C. Consolidation rate in ulnar shortening osteotomy with the APTUS Wrist plate. HAND SURGERY & REHABILITATION 2024; 43:101682. [PMID: 38492803 DOI: 10.1016/j.hansur.2024.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Ulnocarpal impaction syndrome causes pain on the ulnar side of the wrist. Various surgical techniques have been described. Ulnar shortening osteotomy is now a standard treatment. However, it is associated with complications such as non-union of the osteotomy site. The main study objective was to report the rate of radiographic consolidation after ulnar shortening osteotomy with a cutting guide. MATERIAL AND METHODS This multicenter retrospective study of 30 cases reported clinical and radiographic criteria at a minimum 6 month's follow-up. RESULTS The non-union rate was 3.4%. One case presented non-union of the osteotomy site. 87% of patients were satisfied or very satisfied with the procedure. Mean VAS pain rating was 2.7 ± 2.4. Mean QuickDASH and PRWE scores were 24.7 ± 19.2 and 28.6 ± 25. Mean strength on Jamar dynamometer was 27.4 ± 8.9 kg. One patient developed complex regional pain syndrome. Five patients required plate removal for hardware-related discomfort. DISCUSSION Ulna shortening osteotomy with the Aptus Wrist plate provides a standardized approach to the surgical treatment of ulnocarpal impaction syndrome. Compared with other series in the literature, the procedure provided satisfactory consolidation and clinical results.
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Affiliation(s)
- Thomas Daoulas
- Service de Chirurgie Orthopédique, Traumatologique et Urgence Main, Boulevard Tanguy Prigent, CHU de la Cavale Blanche, 29200 Brest, France.
| | - Mathilde Bernard
- Service de Chirurgie de la Main et des Nerfs Périphériques, 2 Boulevard Tonnellé, 37000 Tours, France
| | - Arthur Dellestable
- Service de Chirurgie Orthopédique, Traumatologique et Urgence Main, Boulevard Tanguy Prigent, CHU de la Cavale Blanche, 29200 Brest, France
| | - Hoel Letissier
- Service de Chirurgie Orthopédique, Traumatologique et Urgence Main, Boulevard Tanguy Prigent, CHU de la Cavale Blanche, 29200 Brest, France
| | - Guillaume Bacle
- Service de Chirurgie de la Main et des Nerfs Périphériques, 2 Boulevard Tonnellé, 37000 Tours, France
| | - Clara Sos
- Service de Chirurgie de la Main et des Nerfs Périphériques, 2 Boulevard Tonnellé, 37000 Tours, France
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Shi H, Huang Y, Shen Y, Wu K, Zhang Z, Li Q. Arthroscopic wafer procedure versus ulnar shortening osteotomy for ulnar impaction syndrome: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:149. [PMID: 38378573 PMCID: PMC10880364 DOI: 10.1186/s13018-024-04611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE This study aimed to systematically compare the efficacy and safety of arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) for ulnar impaction syndrome (UIS) treatment. METHODS All the studies included in this meta-analysis compared the efficacy of AWP to USO for UIS and were acquired through a comprehensive search across multiple databases. The meta-analysis was performed by calculating the effect sizes with the Cochrane Collaboration's RevMan 5.4 software. RESULTS A total of 8 articles were included in this analysis, comprising 148 cases in the AWP group and 163 cases in the USO group. The pooled estimates indicated no significant differences in combined Darrow's Criteria or Modified Mayo Wrist Score, Modified Mayo Wrist Score, DASH scores, grip strength, VAS score, and postoperative ulnar variation. On the other hand, the patients in the AWP group exhibited fewer complications (OR = 0.17, 95%CI 0.05-0.54, P = 0.003) and a lower reoperation rate (OR = 0.12, 95%CI 0.05-0.28, P < 0.00001) than those in the USO group. CONCLUSIONS The two surgical techniques were both effective in treating UIS but the AWP group showed fewer complications and a lower reoperation rate. Therefore, AWP may present a superior alternative for UIS treatment.
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Affiliation(s)
- Haifeng Shi
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| | - Yongjing Huang
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Yong Shen
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Ke Wu
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| | - Zhihai Zhang
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Qian Li
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
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Luo L, Yang K, Ye J, Yang Y. Spontaneous tendon rupture caused by positive ulnar variance-claw hand deformity: A case report and literature review. Asian J Surg 2023:S1015-9584(23)00143-4. [PMID: 36764857 DOI: 10.1016/j.asjsur.2023.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Affiliation(s)
- Liang Luo
- Department of Joint Surgery, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, 401121, PR China
| | - Kaiwen Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, PR China; Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, 641000, PR China
| | - Junwu Ye
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, PR China
| | - Yunkang Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, PR China.
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Yang H, Qi W, Zhang F, Zhang Q, Liu Y, Lu Z, Mi J, Zhao G. Comparison of diaphyseal and metaphyseal ulnar shortening osteotomies for the treatment of ulnar impaction syndrome. BMC Musculoskelet Disord 2023; 24:10. [PMID: 36609310 PMCID: PMC9817322 DOI: 10.1186/s12891-022-06070-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is a common surgical procedure for the treatment of ulnar impaction syndrome (UIS). The purpose of this study was to compare the results of metaphyseal and diaphyseal USO. METHODS: This retrospective study compared the clinical outcomes and complications of 32 patients who underwent diaphyseal step-cut USO (n = 10), diaphyseal oblique USO (n = 12), or metaphyseal USO (n = 10). RESULTS Patient characteristics, ulnar variance, wrist range of motion, preoperative pain, grip strength, and functional scores (quick disability of the arm, shoulder, and hand and patient-rated wrist evaluation) were comparable. Both operation time (79.5 vs. 138/139 min) and incision length (7.80 vs. 9.67/13.00 cm) were shorter in the metaphyseal USO than in the diaphyseal oblique/step-cut USO. Compared with diaphyseal oblique/step-cut USO, metaphyseal osteotomies were associated with greater improvement in the pain on postoperative day 3 and shorter bone healing time. The requirements for implant removal were the same among the three groups. No complications were observed in any group. CONCLUSION Compared with diaphyseal USO, metaphyseal USO has advantages for operation time and incision length, early postoperative pain, bone healing in UIS management. The results suggested that metaphyseal USO could be widely applied to the surgical treatment of UIS. However, the long-term outcomes of these techniques still require further evaluation using more large-scale, randomized clinical trials.
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Affiliation(s)
- Haoyu Yang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Weiya Qi
- Department of Orthopedics, Xuzhou Renci Hospital, 221000 Xuzhou, China
| | - Fei Zhang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Qian Zhang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Yuzhou Liu
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Zhengfeng Lu
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Jingyi Mi
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Gang Zhao
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
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Shin EK. Impaction Syndromes About the Wrist. Curr Rev Musculoskelet Med 2022; 16:1-8. [PMID: 36435859 PMCID: PMC9839928 DOI: 10.1007/s12178-022-09809-9] [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] [Accepted: 11/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Impaction syndromes are frequently a source of ulnar-sided wrist pain and patient disability. Differentiating between these entities can be difficult due to significant overlap in their clinical presentations. This manuscript reviews the diagnosis and treatment of three different impaction syndromes: (1) ulnar impaction syndrome, (2) hamate arthrosis lunotriquetral ligament syndrome, and (3) triquetrohamate impaction syndrome. RECENT FINDINGS While non-operative treatment is always recommended upon initial presentation, the duration and extent of treatment are poorly defined. Diagnostic wrist arthroscopy usually confirms the clinical diagnosis and facilitates appropriate surgical management. Pain from ulnar impaction syndrome can be effectively treated with an ulnar shortening osteotomy, which unloads the ulnar aspect of the carpus, but complications have been reported secondary to hardware prominence and nonunion at the osteotomy site. Hamate arthrosis lunotriquetral ligament syndrome can be addressed by arthroscopically or openly excising the proximal pole of the hamate, while triquetrohamate impaction syndrome demands a debridement procedure with partial excision of the impinging triquetrum or hamate. In summary, impaction syndromes are underappreciated clinical entities but are known causes of ulnar-sided wrist pain. Maintaining a high index of suspicion will help to expedite appropriate non-operative and operative treatment. Surgical intervention-if needed-is often curative.
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Affiliation(s)
- Eon K Shin
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia Hand to Shoulder Center, 1203 Langhorne-Newtown Road, Suite 335, Langhorne, PA, 19047, USA.
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Facon JB, Mainard N, Faure PA, Wavreille G, Chantelot C, Auzias P. Results of isolated ulnar shaft shortening osteotomy in the treatment of idiopathic ulnocarpal impaction syndrome. HAND SURGERY & REHABILITATION 2022; 41:589-594. [PMID: 35907617 DOI: 10.1016/j.hansur.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
The objective of this study was to evaluate the results of isolated ulnar shaft shortening osteotomy (USSO) in the treatment of idiopathic ulnocarpal impingement syndrome. This was a two-center retrospective study. All patients older than 18 years who underwent isolated USSO for idiopathic ulnocarpal impingement syndrome between 2006 and 2016 were included. The outcome measures were: patient satisfaction, decrease in pain intensity, change in occupation, QuickDASH and PRWE functional scores, secondary palliative surgery suggesting failure of the ulnar shaft shortening osteotomy, and postoperative ulnar variance. The main complications were analyzed. Thirty-one patients were included. Twenty-six (84%) were satisfied with the procedure. At an average follow-up of 62 months, there was no secondary palliative surgery. Mean pain intensity on VAS was 7/10 (range, 2-10) and 1.7/10 (range, 0-6) preoperatively and postoperatively, respectively, for a mean decrease of 5.3 ± 2.6 points; this decrease was statistically significant (p < 0.001). None of the manual workers had to alter their work. Mean postoperative QuickDASH score was 19.6/100 (range, 0-79.55) and mean postoperative PRWE score was 23/100 (range, 1-85). Mean postoperative ulnar variance was -0.5 mm. As for complications, 61% of patients (n = 19/31) had discomfort related to the plate; 9.7% (n = 3/31) had distal radioulnar osteoarthritis; 4% (n = 1/19) had a fracture after hardware removal; 13% (n = 4/31) had non-union. Despite a high rate of complications, the study confirmed the effectiveness, in terms of pain, of isolated USSO in the treatment of idiopathic ulnocarpal impingement syndrome. LEVEL OF EVIDENCE: IV; retrospective cohort.
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Affiliation(s)
- J-B Facon
- Service de Chirurgie Orthopédique 1, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France.
| | - N Mainard
- Département de Chirurgie Pédiatrique, Hôpital Jeanne de Flandre, Rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - P-A Faure
- Service de Chirurgie Orthopédique 2, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - G Wavreille
- Centre SOS mains, Pôle Clinique Lille Sud, 43 Rue des meuniers, 59810 Lesquin, France
| | - C Chantelot
- Service de Chirurgie Orthopédique 1, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - P Auzias
- Service de Chirurgie Orthopédique 1, Hôpital Roger Salengro, Rue du Professeur Emile Laine, 59037 Lille cedex, France; Centre SOS mains, Pôle Clinique Lille Sud, 43 Rue des meuniers, 59810 Lesquin, France
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Nakamura T, Takagi T. Differentiated Approaches to Treat Lesions of the TFCC Based on new arthroscopic Classification. HANDCHIR MIKROCHIR P 2022; 54:389-398. [PMID: 36037815 DOI: 10.1055/a-1872-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this article, pathology of the TFCC lesions, image diagnosis and arthroscopic examination were described. According to the radiocarpal arthroscopic findings, TFCC lesions are classified into intra-disc lesions (Class 1), radial lesion (Class 2), peripheral disc lesions which indicate slight to moderate DRUJ instability (Class 3) and degenerative lesion (Class 4). The radioulnar ligament (RUL) lesions that indicate moderate to severe DRUJ instability were classified with staging system with DRUJ arthroscopic findings (Stage 1 to 5). Author's treatment algorism with wrist arthroscopic findings including DRUJ arthroscopy was demonstrated and along with this algorism, various arthroscopic and open techniques to treat TFCC injuries were selected and resulted in success. Precise diagnosis of the TFCC lesions helped to select an adequate treatment for each lesion.Dieser Artikel beschreibt die pathologischen Veränderungen des TFCC sowie deren Befunde in der Bildgebung und Arthroskopie. Am TFCC lassen sich mittels Arthroskopie bei Sicht von radiokarpal zentrale (Typ 1), radiale (Typ 2) sowie periphere Läsionen (Typ 3), die mit einer moderaten Instabilität des distalen Radioulnargelenkes (DRUG) einhergehen, und degenerative Läsionen (Typ 4) unterscheiden. Läsionen der radioulnaren Bänder, die mit einer moderaten bis ausgeprägten Instabilität des DRUG vergesellschaftet sind, werden anhand der Befunde bei der DRUG-Arthroskopie in fünf Stadien eingeteilt. Diesen unterschiedlichen Befunden angepasst wurde ein Behandlungsalgorithmus mit verschiedenen arthroskopischen und offenen Verfahren entwickelt, der sich als erfolgreich erwies. Eine exakte Klassifizierung von TFCC-Läsionen ermöglicht die Wahl des für die jeweilige Läsion adäquaten Therapieverfahrens.
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Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan.,Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Takehilko Takagi
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya-ku, Japan
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Teunissen JS, Feitz R, Al Shaer S, Hovius S, Selles RW, Van der Heijden B. Return to Usual Work Following an Ulnar Shortening Osteotomy: A Sample of 111 Patients. J Hand Surg Am 2022; 47:794.e1-794.e11. [PMID: 34511292 DOI: 10.1016/j.jhsa.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to analyze the median time until patients performed their usual work following an ulnar shortening osteotomy (USO). The secondary aim was to identify factors influencing the median time until return to their usual work. METHODS We used a retrospective cohort of patients with ongoing data collection from our institution in the Netherlands. Patients with paid employment who underwent USO were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months after surgery. The probability of and median time until return to usual work were assessed using an inverted Kaplan-Meier analysis. Factors influencing the return to usual work were evaluated using multivariable Cox proportional hazard regression. RESULTS In total, 111 patients who underwent USO were included, with a mean age of 46 years. The probability of returning to usual work in the first year was 92%, and the median time was 12 weeks. The type of work was independently associated with a return to work, with median times of 8, 12, and 14 weeks for light, moderate, and heavy physical work, respectively. We did not find differences in return to usual work based on age, sex, duration of complaints until surgery, treatment side, smoking status, the preoperative Patient-Rated Wrist Evaluation score, or whether the osteotomy was performed freehand or with an external cutting device. CONCLUSIONS Half of the patients that underwent USO fully performed their usual work by 12 weeks following surgery. We found that 92% of the patients performed their usual work within 1 year after surgery. We found a large variation in the time until a return to work based on the type of work. Surgeons can use this data to inform patients on the rehabilitation phase after USO. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Joris Sebastiaan Teunissen
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands.
| | - Reinier Feitz
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Sanharib Al Shaer
- Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Steven Hovius
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Brigitte Van der Heijden
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
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Yu H, Wang T, Wang Y, Zhu Y. Ulnar shortening osteotomy vs. wafer resection for ulnar impaction syndrome: A systematic review and meta-analysis. Int J Surg 2022; 104:106725. [PMID: 35738540 DOI: 10.1016/j.ijsu.2022.106725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is the most common operation to treat ulnar impaction syndrome (UIS). An alternative to USO is the arthroscopic wafer procedure (AWP). Few studies have directly compared USO and AWP in patients with UIS. This study compared ulnar shortening osteotomy (USO) versus arthroscopic wafer procedure (AWP) for UIS treatment. MATERIALS AND METHODS PubMed, EMBASE, the Cochrane Library, Wanfang, and CNKI were systematically searched for reports published before March 2021. The outcomes included Modified Mayo Wrist Score, Darrow's Criteria, Disability of Arm, Shoulder, and Hand (DASH), grip strength, visual analog scale (VAS) score, and time to resume manual occupation. RESULTS Seven studies (133 and 118 patients with USO and AWP, respectively) were included. There were no differences in combined Darrow's Criteria or Modified Mayo Wrist Score, Modified Mayo Wrist Score, Darrow's Criteria, revision rate, DASH score, VAS score, and time to resume manual occupation. Grip strength was better with AWP (SMD = -0.73, 95%CI: -1.36, -0.11, P = 0.022). Differences were seen for ulna positive variation, favoring USO (WMD = -2.75, 95%CI: -5.17, -0.33, P = 0.026). CONCLUSIONS In the surgical treatment of UIS, AWP might be associated with improved grip strength, while USO seems to show better results in treating pronounced ulna positive variation. Only evidence of moderate quality could be included in this meta-analysis.
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Affiliation(s)
- Hao Yu
- Orthopeadic Surgery Department, The First Hospital of China Medical University, Shenyang, China.
| | - Ting Wang
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China.
| | - Yansheng Wang
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China.
| | - Yue Zhu
- Orthopeadic Surgery Department, The First Hospital of China Medical University, Shenyang, China.
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Lerma EG, Garcia FJL, Caraballo AM, Royo DS. Rehabilitation in Triangular Fibrocartilage Complex Injuries: Treatment Algorithm. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1748854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractInjuries to the triangular fibrocartilage complex (TFCC) can lead to instability of the distal radioulnar joint (DRUJ). In fact, they are the most frequent cause of it. But, in other cases, depending on the type of injury, the DRUJ remains stable. This will condition different types of treatments, from conservative management to the different options of surgical treatment. Since a controversy persists regarding the management of these lesions, our purpose is to disclose the foundations of the rehabilitation treatment and propose an algorithm of treatment according to the different types of injuries and their repairs.
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Affiliation(s)
- Eva Guisasola Lerma
- Hand and Upper Limb Surgery Unit, Hospital QuirónSalud Valencia, Valencia, Spain
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Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years. Bone Jt Open 2022; 3:375-382. [PMID: 35514114 PMCID: PMC9134835 DOI: 10.1302/2633-1462.35.bjo-2022-0031.r1] [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] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. Methods Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. Results Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). Conclusion Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.
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Affiliation(s)
- Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Mark J. W. van der Oest
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Steven E. R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Brabant, The Netherlands
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Cunningham DJ, Pidgeon TS, Saltzman EB, Mather RC, Ruch DS. The Value Added of Advanced Imaging in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Pathology. J Hand Surg Am 2022; 47:19-30.e8. [PMID: 34481677 DOI: 10.1016/j.jhsa.2021.06.027] [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: 07/04/2019] [Revised: 04/12/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Pathology of the triangular fibrocartilage complex is a prevalent cause of ulnar-sided wrist pain that presents a diagnostic challenge. We hypothesized that a history and physical examination (H&P) would be more cost-effective alone or with diagnostic injection than with magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) in the diagnosis and treatment of a symptomatic triangular fibrocartilage complex abnormality. METHODS A simple-chain decision analysis model was constructed to assess simulated subjects with ulnar-sided wrist pain and normal radiographs using several diagnostic algorithms: H&P alone, H&P + injection, H&P with delayed advanced imaging (MRI or MRA), and H&P + injection with delayed advanced imaging (MRI or MRA). Three years after diagnosis, effectiveness was calculated in Disabilities of the Arm, Shoulder, and Hand-adjusted life years. Costs were extracted from a commercial insurance database using US dollars. A probabilistic sensitivity analysis with 10,000 second-order trials with sampling of parameter distributions was performed. One-way and 2-way sensitivity analyses were performed. RESULTS All strategies had similar mean effectiveness between 2.228 and 2.232 Disabilities of the Arm, Shoulder, and Hand-adjusted life years, with mean costs ranging from $5,584 (H&P alone) to $5,980 (H&P, injection, and MRA). History and physical examination alone or with injection were the most cost-effective strategies. History and physical examination alone was the most preferred diagnostic strategy, though H&P + injection and H&P with delayed MRA were preferred with adjustments in willingness-to-pay and parameter inputs. As willingness-to-pay increased considerably (>$65,000 per Disabilities of the Arm, Shoulder, and Hand-adjusted life year), inclusion of MRA became the most favorable strategy. CONCLUSIONS Advanced imaging adds costs and provides minimal increases in effectiveness in the diagnosis and treatment of a symptomatic triangular fibrocartilage complex abnormality. The most cost-effective strategy is H&P, with or without diagnostic injection. Magnetic resonance arthrogram may be favored in situations with a high willingness-to-pay or poor examination characteristics. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/Decision Analysis IV.
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Affiliation(s)
| | - Tyler S Pidgeon
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | | | | | - David S Ruch
- Department of Orthopaedic Surgery, Duke University, Durham, NC
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14
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Abstract
OBJECTIVE Focal cartilage injuries, and posttraumatic osteoarthritis (OA) in the wrist are likely common and a cause of wrist pain. To estimate the incidence of cartilage lesions and to understand the pathomechanisms leading to wrist cartilage injuries and OA, a literature review on the subject was performed combined with a presentation of one of the authors' own experience. DESIGN This study includes a literature review of the topic. As a comparison to the review findings, the observations of one of the authors' consecutive 48 wrist arthroscopies, were assessed. PubMed, Scholar, and Cochrane databases were searched using the keywords "cartilage injury AND wrist AND treatment" and "wrist AND cartilage AND chondral AND osteochondral AND degenerative OA." :RESULT A total of 11 articles, including 9 concerning chondral and osteochondral repair and treatment and 2 regarding posttraumatic OA, were retrieved. The cartilage repair treatments used in these articles were drilling, osteochondral autograft, juvenile articular cartilage allograft, and chondrocyte implantation. One article displayed concomitant cartilage injuries in displaced distal radius fractures in 32% of the patients. The review of our findings from a 1-year cohort of wrist arthroscopies showed 17% cartilage injuries. CONCLUSION There is a lack of knowledge in current literature on cartilage injuries and treatment, as well as posttraumatic OA in the wrist. Cartilage injuries appear to be common, being found in 17% to 32% of all wrist arthroscopies after trauma, but no guidelines regarding conservative or surgical treatment can be recommended at the moment. Larger prospective comparative studies are needed.
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Affiliation(s)
- Jonny K. Andersson
- Department of Surgery, Aspetar
Orthopaedic and Sports Medicine Hospital, Doha, Qatar,Department of Orthopaedics, Institute
of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg,
Sweden,Jonny K. Andersson, Aspetar Orthopaedic and
Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda
St, Doha, Qatar.
| | - Elisabet Hagert
- Arcademy, H.M. Queen Sophia Hospital,
Stockholm, Sweden,Department of Clinical Science and
Education, Karolinska Institutet, Stockholm, Sweden,Department of Health Promotion Science,
Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University,
Stockholm, Sweden
| | - Mats Brittberg
- Cartilage Research Unit, Region Halland
Orthopaedics, Kungsbacka Hospital, University of Gothenburg, Kungsbacka,
Sweden
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15
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Fukuoka M, Nakamura T, Nishiwaki M, Toyama Y, Matsumoto M, Nakamura M, Sato K. Effects of peripheral tears of the triangular fibrocartilage complex on distal radioulnar joint stability: A biomechanical study. J Orthop Sci 2021; 26:1008-1013. [PMID: 33303299 DOI: 10.1016/j.jos.2020.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral triangular fibrocartilage complex (TFCC) tears may induce instability of the distal radioulnar joint (DRUJ). In this biomechanical study, simulated peripheral tears of the TFCC were examined on the stability of the DRUJ. Restabilization effect of the DRUJ by ulnar shortening and direct repair of those injuries were sequentially examined. METHOD The DRUJ stiffness was measured in intact, simulated two types of peripheral tears (ulnar and extended ulnodorsal) at three forearm positions: neutral, 60° pronation and 60° supination in 8 fresh frozen cadaver specimens. After the tears were sutured with stitches or after simulated ulnar shortening of 3 mm, the DRUJ stiffness was again measured. RESULTS The ulnar and ulnodorsal TFCC tears decreased the DRUJ stiffness significantly compared with the intact in all forearm positions. When ulnar shortening was done for the ulnar tear, the DRUJ stiffness increased significantly in the neutral and 60° pronated positions. When the ulnar TFCC tear was repaired, the DRUJ stiffness increased significantly in all forearm positions. DRUJ stiffness did not increase either with ulnar shortening or repair in ulnodorsal tear of the TFCC, however. CONCLUSION The simulated TFCC tears indicated significant loss of DRUJ stiffness. Direct repair or ulnar shortening was effective only on treatment of the ulnar tear of the TFCC in this study.
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Affiliation(s)
- Masatoshi Fukuoka
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan.
| | - Masao Nishiwaki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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16
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Abstract
Triangular fibrocartilage complex (TFCC) tears can cause ulnar-sided wrist pain in children and adolescents following acute rotational injury or prior distal radius fracture. Surgical treatment, guided by the Palmer classification, is considered after activity modification and occupational therapy. All concomitant wrist pathologies, such as distal radioulnar joint instability, ulnocarpal impaction, and distal radius malunion, must be recognized and addressed at the time of TFCC debridement or repair. This article reviews recent literature guiding clinical evaluation and surgical treatment of children and adolescents with TFCC injuries. The authors' techniques for arthroscopic-assisted outside-in repair of Palmer 1B and 1D tears are described.
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Affiliation(s)
- Stella J Lee
- Department of Surgery, Anna Jaques Hospital, 25 Highland Avenue, Newburyport, MA 01950, USA.
| | - Donald S Bae
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan 2nd Floor, Boston, MA 02115, USA
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17
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Hontani K, Matsui Y, Kawamura D, Urita A, Momma D, Hamano H, Iwasaki N. Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome. Sci Rep 2021; 11:17891. [PMID: 34504202 PMCID: PMC8429458 DOI: 10.1038/s41598-021-97398-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022] Open
Abstract
Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.
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Affiliation(s)
- Kazutoshi Hontani
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroki Hamano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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18
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Im JH, Lee JY, Kang HV. The Combined Procedure of Ulnar Metaphyseal Shortening Osteotomy With Triangular Fibrocartilage Complex Foveal Knotless Repair. J Hand Surg Am 2021; 46:822.e1-822.e7. [PMID: 33820657 DOI: 10.1016/j.jhsa.2021.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/29/2020] [Accepted: 01/29/2021] [Indexed: 02/02/2023]
Abstract
Ulnar impaction syndrome (UIS) and triangular fibrocartilage complex (TFCC) tear are common causes of ulnar-sided wrist pain. As a standard surgical treatment, ulnar-shortening osteotomy (USO) and TFCC repair are used respectively. Patient spectrums of UIS accompanied by distal radioulnar joint instability or traumatic TFCC foveal tear with UIS symptoms exist, and both USO and TFCC repair are necessary for treating some of these patients. However, there have been few reports on the procedure for performing these 2 operations concurrently. We introduce a combined procedure to concurrently perform USO and TFCC repair. We performed a USO in the ulnar metaphysis using a locking plate and open TFCC knotless repair using a suture anchor at the ulnar fovea. In this technique, USO is conducted in the metaphysis, which is favorable to union, using a small plate that is easy to handle, and knotless TFCC repair can be performed simultaneously through a single small incision.
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Affiliation(s)
- Jin-Hyung Im
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon
| | - Joo-Yup Lee
- Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
| | - Han-Vit Kang
- Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
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Roulet S, Gubbiotti L, Lakhal W, Chaves C, Marteau E, Laulan J, Bacle G. Ulna shortening osteotomy for ulnar impaction syndrome: Impact of distal radioulnar joint morphology on clinical outcome. Orthop Traumatol Surg Res 2021; 107:102970. [PMID: 34052512 DOI: 10.1016/j.otsr.2021.102970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of ulnar impaction syndrome (UIS) is based on ulnocarpal decompression, which may be achieved by ulna shortening osteotomy. The aim is to restore zero or negative ulnar variance. Tolat et al. described 3 distal radioulnar joint (DRUJ) morphologic types: vertical, oblique and reverse. Joint type has been thought to influence the clinical result of shortening, especially in the reverse type. HYPOTHESIS DRUJ type does not influence clinical results in ulna shortening osteotomy. MATERIAL AND METHODS Twenty-nine wrists were operated on in 27 patients: 13 female, 14 male; mean age at surgery, 43 years (range, 18-72 years). In 20 cases, UIS was idiopathic and in 7 post-traumatic. Mean preoperative ulnar variance was 3.6mm (range, 2-18mm). The osteotomy was fixed by screwed plate. RESULTS Twenty-five patients (27 wrists) were assessed at a mean 64 months (range, 18 months to 13 years). There were no cases of infection or hematoma. DRUJ was type 1 (vertical) in 6 cases (22%), type 2 (oblique) in 14 (52%) and type 3 (reverse) in 7 (26%). Mean postoperative pain score on VAS was 0.7/10 (range, 0-4); 9 wrists remained painful. Mean Quick-DASH was 16.9 (range, 0-48) and mean PRWE 21.9 (range, 16.9-59). Thirteen patients were very satisfied, 11 satisfied, 1 moderately satisfied, and 2 dissatisfied. Mean postoperative ulnar variance was -0.1mm (range, -4 to +8mm). Three wrists developed osteoarthritis, all following traumatic UIS. There were no significant correlations between DRUJ type and other clinical or radiological parameters. DISCUSSION Ulna shortening osteotomy has proven efficacy in UIS. The literature reports excellent or good results in 75% of cases. In the present study, 96% of patients considered themselves cured or improved by surgery, and none reported worsening. Ulna shortening osteotomy can be used in all 3 DRUJ types; DRUJ coronal morphology does not impact clinical result. LEVEL OF EVIDENCE IV-retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France.
| | - Laura Gubbiotti
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Walid Lakhal
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Camilo Chaves
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Emilie Marteau
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Jacky Laulan
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Guillaume Bacle
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
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20
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Huang HK, Lee SK, Huang YC, Yin CY, Chang MC, Wang JP. Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study. BMC Musculoskelet Disord 2021; 22:136. [PMID: 33536011 PMCID: PMC7860176 DOI: 10.1186/s12891-021-04029-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch. METHODS We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients. RESULTS We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36-179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o-23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o-11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0-1; SD, 0.4) at rest and 1.3 (range, 0-3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3-34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70-100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength. CONCLUSIONS For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.
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Affiliation(s)
- Hui-Kuang Huang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Steve K Lee
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA
| | - Yi-Chao Huang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Yu Yin
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Ming-Chau Chang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jung-Pan Wang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
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21
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Auzias P, Delarue R, Camus EJ, Van Overstraeten L. Ulna shortening osteotomy versus arthroscopic wafer procedure in the treatment of ulnocarpal impingement syndrome. HAND SURGERY & REHABILITATION 2020; 40:156-161. [PMID: 33160084 DOI: 10.1016/j.hansur.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Post-traumatic or constitutional ulnar impaction syndrome can be treated by shortening the ulna. This can be achieved by diaphyseal or metaphyseal osteotomy, or by arthroscopic epiphyseal resection. The objective of this study was to compare the results of the diaphyseal shortening osteotomy (USO) and arthroscopic wafer procedure (AWP) of the ulna in this indication. This was a retrospective case series of 33 patients operated for ulnar impaction syndrome by the same surgeon between 1997 and 2017. The diagnosis was made based on pain on the ulnar edge of the wrist with positive provocative tests. Radiographs were made and CT arthrography or MRI were used to confirm the diagnosis. Per-and post-operative assessments were functional (DASH and PRWE scores), clinical (pain, range of motion and grip strength) and radiographic. Diaphyseal ulnar shortening osteotomy (USO) was performed in 9 patients using a volar plate and a cutting guide. Twenty-four patients underwent an arthroscopic wafer procedure. Mean follow-up was 103 ± 8 months in the USO group versus 55 ± 4 months in the AWP group. There was no significant difference between groups in pain levels (1.2/10 in the USO group versus 0.9/10 in the AWP group, p = 0.88), grip strength (39 Kg in the USO group versus 34 Kg in the AWP group, p = 0.27) and PRWE score (5,8/100 in the USO group versus 11,2 in the AWP group, p = 0.34), and DASH score (25/100 in the USO group versus 28 in the AWP group, p = 0.63). The time away from work was long in the USO group than in the AWP group (7.86 months versus 3.75 months) (p = 0.002). Seven patients were reoperated in the USO group (5 plate removal, 1 nonunion and 1 delayed union) versus 3 in the AWP group (1 ECU stabilization, 1 ablation for painful ulnar styloid due to nonunion and 1 wrist denervation) (p = 0.0004). The study found no clinical differences between these two techniques except the return to work time. In our series, diaphyseal USO was associated with a greater number of reoperations than the AWP.
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Affiliation(s)
- P Auzias
- SEL chirurgie de la main et du pied, 94, avenue Gustave Delory, 59810 Lesquin, France.
| | - R Delarue
- CHRU de Lille, rue du Professeur Emile Laine, 59037 Lille, France
| | - E J Camus
- SEL chirurgie de la main et du pied, 94, avenue Gustave Delory, 59810 Lesquin, France
| | - L Van Overstraeten
- Hôpital Erasme ULB, route de Lennik, 1070 Bruxelles, Belgique; Hand and Foot Surgery Unit, Rue Pierre Caille 9, Tournai, Belgique
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Cha SM, Shin HD, Ahn BK. Refracture after plate removal following ulnar shortening osteotomy for ulnar impaction syndrome - a retrospective case-control study. J Plast Surg Hand Surg 2020; 55:48-55. [PMID: 33019843 DOI: 10.1080/2000656x.2020.1828900] [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] [Indexed: 10/23/2022]
Abstract
LEVEL OF EVIDENCE Level III, case-control study.
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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
| | - Byung Kuk Ahn
- 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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O'Shaughnessy M, Shapiro LM, Schultz B, Retzky J, Finlay AK, Yao J. Morphology at the Distal Radioulnar Joint: Identifying the Prevalence of Reverse Obliquity. J Wrist Surg 2020; 9:417-424. [PMID: 33042645 PMCID: PMC7540646 DOI: 10.1055/s-0040-1713158] [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] [Received: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
Background Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS. Purpose As prevalence of reverse oblique morphology has been under-reported, this study aims to better define the prevalence of reverse oblique morphology in the adult population. Methods Institutional Review Board-approved review of 1,000 radiographs over a 2-year period was performed. Demographic data and radiographic measurements were recorded (ulnar variance, notch inclination, and presence of arthritis). Correlation tests, a test of proportions, a t -test, and linear and logic regression tests were used to examine associations between ulnar variance, sigmoid inclination, sex, age, and presence of arthritis. Results One thousand radiographs were analyzed revealing prevalence rates of: parallel-68%, oblique-26%, and reverse oblique-6%. Females were significantly more likely to have reverse inclination. No significant correlation was noted for morphology by age. Ulna positive variance was negatively correlated with reverse inclination. DRUJ arthritis was noted in 14% of patients. Higher sigmoid inclination was associated with higher odds of presence of arthritis, adjusting for sex and age. Higher incidence of arthritis was noted among patients with the oblique (20.8%) or reverse oblique (24.6%) compared with parallel (10.5%) morphology. Conclusion This series of 1,000 radiographs demonstrates a 6% overall prevalence of reverse obliquity. This large dataset allows for better quantification of the prevalence of DRUJ morphologies and determination of correlations that have clinical implications for patients with ulnar-sided wrist pathology. Level of Evidence This is a Level IV study.
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Affiliation(s)
| | - Lauren M. Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Blake Schultz
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Julia Retzky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrea K. Finlay
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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Kwon BC, Lee JH, Lee SY. What Is the Effect of the Ulnar-Plus Variance on the Outcomes of Arthroscopic Repair of the Peripheral Ulnar-Side Triangular Fibrocartilage Complex Tear? Arthroscopy 2020; 36:2415-2422. [PMID: 32442714 DOI: 10.1016/j.arthro.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the outcomes of arthroscopic repair of peripheral ulnar-side triangular fibrocartilage complex (TFCC) tears between patients with and without ulnar-plus variance (UPV) and to identify factors associated with index surgery failure in these patients. METHODS We retrospectively analyzed 50 consecutive patients who underwent arthroscopic repair of peripheral ulnar-side TFCC tears from June 2014 to February 2018. We selected patients who were aged at least 18 years and underwent arthroscopic repair of peripheral ulnar-side TFCC tears. We excluded those with a fractured or dislocated wrist, ulnar impaction syndrome, degenerative or inflammatory arthritis of the wrist, or neurologic conditions that affect upper-extremity function, as well as those who received less than 12 months' follow-up. We evaluated the patients with a visual analog scale for pain in 3 domains (overall, with hard work, and at rest), the Patient-rated Wrist Evaluation, range of motion, and grip strength. Clinical outcomes and arthroscopic findings were compared between patients with and without UPV (UPV group and non-UPV group, respectively). We calculated the relative risk and 95% confidence interval for younger age (<30 years), sex, UPV, and coexisting degenerative central TFCC tear (type 2 tear) to determine the risk factors for arthroscopic repair failure. RESULTS No significant differences were noted between the 2 groups regarding visual analog scale pain and Patient-rated Wrist Evaluation scores and rates of excellent or improved outcomes (P > .05). Arthroscopic repair failure was found in 4 patients. A coexisting type 2 TFCC tear was the only significant risk factor (relative risk, 49.5; 95% confidence interval, 2.94-83.96; P = .007) for arthroscopic repair failure. CONCLUSIONS UPV did not significantly affect the outcomes of arthroscopic repair of peripheral ulnar-side TFCC tears. However, coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in these patients. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- Bong Cheol Kwon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
| | - Jeong Hwan Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Suk Yoon Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Jung HS, Park MJ, Won YS, Lee GY, Kim S, Lee JS. The correlation between shape of the sigmoid notch of the distal radius and the risk of triangular fibrocartilage complex foveal tear. Bone Joint J 2020; 102-B:749-754. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1284.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to analyze the association between the shape of the distal radius sigmoid notch and triangular fibrocartilage complex (TFCC) foveal tear. Methods Between 2013 and 2018, patients were retrospectively recruited in two different groups. The patient group comprised individuals who underwent arthroscopic transosseous TFCC foveal repair for foveal tear of the wrist. The control group comprised individuals presenting with various diseases around wrist not affecting the TFCC. The study recruited 176 patients (58 patients, 118 controls). The sigmoid notch shape was classified into four types (flat-face, C-, S-, and ski-slope types) and three radiological parameters related to the sigmoid notch (namely, the radius curvature, depth, and version angle) were measured. The association of radiological parameters and sigmoid notch types with the TFCC foveal tear was investigated in univariate and multivariate analyses. Receiver operating characteristic curves were used to estimate a cut-off for any statistically significant variables. Results Univariate analysis showed that the flat-face type was more prevalent in the patients than in the control group (43% vs 21%; p = 0.002), while the C-type was lower in the patients than in the control group (3% vs 17%; p = 0.011). The depth and version angle of sigmoid notch showed a negative association with the TFCC foveal tear in the multivariate analysis (depth: odds ratio (OR) 0.380; p = 0.037; version angle: OR 0.896; p = 0.033). Estimated cut-off values were 1.34 mm for the depth (area under the curve (AUC) = 0.725) and 10.45° for the version angle (AUC = 0.726). Conclusion The proportion of flat-face sigmoid notch type was greater in the patient group than in the control group. The depth and version angle of sigmoid notch were negatively associated with TFCC foveal injury. Cite this article: Bone Joint J 2020;102-B(6):749–754.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, South Korea
| | - Min J. Park
- Department of Orthopedic Surgery, Samsung Medical Center, SunKyuKwan University School of Medicine, Seoul, South Korea
| | - Yoo-Sun Won
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, South Korea
| | - Guen Y. Lee
- Department of Radiology, Medical Center of Chung-Ang University School of Medicine, Seoul, South Korea
| | - Sujin Kim
- Department of Radiology, Medical Center of Chung-Ang University School of Medicine, Seoul, South Korea
| | - Jae S. Lee
- Department of Orthopaedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, South Korea
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Nuñez FA, Marquez-Lara A, Newman EA, Li Z, Nuñez FA. Determinants of Pain and Predictors of Pain Relief after Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome. J Wrist Surg 2019; 8:395-402. [PMID: 31579549 PMCID: PMC6773568 DOI: 10.1055/s-0039-1692481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Background The purpose of this study is to characterize patient- and surgery-specific factors associated with perioperative pain level in patients undergoing ulnar shortening osteotomy (USO) for ulnar impaction syndrome (UIS). We hypothesize that preoperative opiate consumption, tobacco utilization, and severity of ulnar variance will be associated with less postoperative pain relief. Methods All cases of USO between January 2010 and December 2016 for management of UIS were retrospectively reviewed. Patient demographics, smoking status, type of labor, and opioid utilization before surgery were recorded. Radiographic measurements for ulnar variance, radial tilt and inclination, as well as triangular fibrocartilage complex and distal radial-ulnar joint (DRUJ) morphology were assessed. Pre- and postoperative pain score were recorded. Regression analysis was performed to determine predictors of pain scores. Results A total of 69 patients were included for the final analysis with a mean age of 44 years (range 17-73 years). Seventeen patients reported use of daily opioid medications at the time of surgery (25%). Patients who used opioid analgesics daily, active laborers, smokers, and patients involved in worker compensation claims had significantly less pain relief after surgery. Patients with osteotomy performed at the metaphysis had significantly more pain relief than patients that had diaphyseal osteotomy. Regression analysis identified tobacco utilization and anatomic site of osteotomy as independent predictors of postoperative pain. Conclusion The results from this study identified smoking and location of osteotomy as independent predictors of postoperative pain relief. While smoking cessation is paramount to prevent delayed/nonunion it may also help improve pain relief following USO. The potential to achieve greater shortening with a metaphyseal osteotomy suggests that in addition to the mechanical unloading the carpus, pain relief after USO may also stem from tensioning the ulnar collateral ligaments of the wrist, the ECU subsheath, and the radioulnar ligaments. Level of Evidence This is a Level III, therapeutic study.
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Affiliation(s)
- Fiesky A. Nuñez
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alejandro Marquez-Lara
- Department of Orthopaedic surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elizabeth A. Newman
- Department of Orthopaedic surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Zhongyu Li
- Department of Orthopaedic surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fiesky A. Nuñez
- Department of Orthopaedic surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse Injuries of the Wrist. Radiol Clin North Am 2019; 57:957-976. [DOI: 10.1016/j.rcl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Isa AD, Mcgregor ME, Padmore CE, Langohr DG, Johnson JA, King GJW, Suh N. An In Vitro Study to Determine the Effect of Ulnar Shortening on Distal Forearm Loading During Wrist and Forearm Motion: Implications in the Treatment of Ulnocarpal Impaction. J Hand Surg Am 2019; 44:669-679. [PMID: 31171375 DOI: 10.1016/j.jhsa.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/12/2019] [Accepted: 04/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of ulnar shortening on distal forearm loading following simulated dynamic motion. METHODS Ulnar shortening was simulated using a custom-built adjustable implant to simulate up to 4 mm of ulnar shortening (-4 mm) in 9 cadaveric extremities. Load cells were placed in the distal ulna and radius to quantify axial loading. Using a wrist and forearm motion simulator, absolute and percentage loads were measured during dynamic flexion, ulnar deviation (UD), flexion dart throw (DT), and pronation. RESULTS There was a significant decrease in absolute and percentage distal ulnar loads at each interval of ulnar shortening during flexion, UD, DT, and pronation. The distal ulna bore no compressive loads, and in fact, tensile loads were measured in the ulna at 2 mm of ulnar shortening during DT and pronation, at 3 mm during flexion, and at 4 mm during UD. CONCLUSIONS A progressive decrease in distal ulnar loads with generation of tensile loads was observed with sequential ulnar shortening. CLINICAL RELEVANCE Ulnar shortening greater than 2 mm can result in tensile loading in the distal ulna. When managing ulnar impaction syndrome, excessive shortening may not be required to provide relief of symptoms.
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Affiliation(s)
| | | | | | | | - James A Johnson
- University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Graham J W King
- University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Nina Suh
- University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
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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] [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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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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Tsukuda Y, Kawamura D, Matsui Y, Iwasaki N. Morphological characteristics of the sigmoid notch of the distal radius affect the stress distribution patterns in the distal radioulnar joint. J Hand Surg Eur Vol 2019; 44:496-502. [PMID: 30309275 DOI: 10.1177/1753193418803522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to clarify the effects of morphological patterns of the sigmoid notch on the stress distribution across the articular surface of the distal radioulnar joint using a computed tomography osteoabsorptiometry method. Fourteen wrists from 13 patients were classified into two groups according to the type of sigmoid notch, namely the 'C' type and ski-slope sigmoids, and the percentages of high-density areas on the articular surface were quantitatively analysed. The percentage of the high-density area of the dorsal region in the ski-slope sigmoid group was significantly greater than that of the 'C' type sigmoid group (16% vs 4.1%) and of the volar region of the ski-slope sigmoid group (16% vs 2.4%). The results indicate that bony morphological differences in the radial sigmoid notch affect the stress distribution pattern through the distal radioulnar joint.
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Affiliation(s)
- Yukinori Tsukuda
- 1 Department of Orthopaedic Surgery, Otaru General Hospital, Otaru, Japan
| | - Daisuke Kawamura
- 2 Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Matsui
- 2 Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- 2 Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Shim JI, Im JH, Lee JY, Kang HV, Cho SH. Changes in Ulnar Variance after a Triangular Fibrocartilage Complex Tear. J Wrist Surg 2019; 8:30-36. [PMID: 30723599 PMCID: PMC6358446 DOI: 10.1055/s-0038-1668153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Purpose The relationship between triangular fibrocartilage complex (TFCC) tear and ulnar impaction syndrome has not been fully understood. We hypothesized that a TFCC tear could change the ulnar variance, which may be the cause of ulnar impaction syndrome. Patients and Methods A total of 72 patients who underwent TFCC foveal repair between January 2011 and June 2016 were included in this retrospective study. Among them, 44 patients diagnosed with TFCC foveal tear with distal radioulnar joint instability and no ulnar impaction syndrome underwent TFCC foveal repair only (group A) and 28 patients diagnosed with TFCC foveal tear with ulnar impaction syndrome underwent TFCC foveal repair and ulnar shortening osteotomy simultaneously (group B). We measured their ulnar variances in preoperative, postoperative, and last follow-up plain radiography. We also compared them with the ulnar variance of the contralateral (uninjured) wrist. Postoperative clinical outcomes, such as range of motions of the wrist, the visual analog scale (VAS) for pain, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, were assessed. Results Ulnar variance increased after TFCC tears compared with that on the uninjured side in both groups (group A: 0.98 vs. 0.52 mm, p = 0.013; group B: 2.71 vs. 2.13 mm, p = 0.001). Once the TFCC was repaired, ulnar variance decreased (group A: 0.98 to 0.01 mm, p < 0.01; group B: 2.71 to 0.64 mm, p < 0.01). However, it was increased on the last follow-up radiograph (group A: 0.01 to 0.81 mm, p < 0.01; group B: 0.64 to 1.05 mm, p = 0.004). There were no significant improvement of range of motion, except for pronation-supination motion ( p = 0.04). Mean grip strength increased from 56.8 to 70.8% of the contralateral unaffected hand at the last assessment ( p = 0.01). Mean VAS for pain decreased from 7.4 ± 2.5 preoperatively to 2.7 ± 2 postoperatively ( p = 0.001). The QuickDASH score significantly improved from 45 to 9 ( p = 0.001). Conclusion Ulnar variance may be changed after a TFCC tear. In our study, it decreased after TFCC foveal repair. However, as time went on, the ulnar variance increased again, which could be one of the causes of ulnar impaction syndrome and ulnar-sided wrist pain. Level of Evidence This is a therapeutic Level IV study.
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Affiliation(s)
- Jung-In Shim
- Department of Orthpaedic Surgery, St. Vincent's Hospital, Catholic University of Korea, Gyeonggi-Do, Korea
| | - Jin-Hyung Im
- Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsangnam-Do, Korea
| | - Joo-Yup Lee
- Department of Orthpaedic Surgery, St. Vincent's Hospital, Catholic University of Korea, Gyeonggi-Do, Korea
| | - Han-Vit Kang
- Department of Orthpaedic Surgery, St. Vincent's Hospital, Catholic University of Korea, Gyeonggi-Do, Korea
| | - Sung-Hyun Cho
- Department of Orthpaedic Surgery, St. Vincent's Hospital, Catholic University of Korea, Gyeonggi-Do, Korea
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Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes. J Pediatr Orthop 2018; 38:e618-e622. [PMID: 30134350 DOI: 10.1097/bpo.0000000000001243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) tears have been treated with increasing frequency in pediatric and adolescent patients over the past decade. There is little information on these injuries in young athletes and a scarcity of data regarding their ability to return to preinjury levels of athletic participation. The purpose of this study was to review the outcomes of pediatric and adolescent athletes with operatively treated TFCC tears with or without a concurrent ulnar shortening osteotomy and to determine their ability to return to their preoperative level of activity. METHODS A retrospective chart review was performed for all patients who underwent operative treatment of TFCC tears between 2006 and 2012 within one Upper Extremity practice. Patients were included if they were high-level athletes, unable to participate in their sport secondary to wrist pain and desired to return to their sport. All operative patients had imaging studies and clinical findings consistent with TFCC injury as the primary source of their activity-limiting pain and had failed nonoperative management prior to surgery. Patients without at least 3 months of documented postoperative follow up were excluded. RESULTS In total, 22 patients were included in the chart review with 20 patients willing to participate in a telephone survey and PODCI. Eighty percent of patients returned to their sport following operative treatment of their injury at an average of 4.8 months. Seven of the 22 patients underwent a concurrent ulnar shortening osteotomy for ulnar positive variance. All 20 patients reported satisfaction with the outcomes of their surgery and treatment. CONCLUSIONS Operative treatment of TFCC injuries in adolescent and pediatric athletes after failure of conservative treatment allowed return to sport at the previous level of participation. Concurrent ulnar shortening osteotomy in the setting of ulnar positive variance did not prohibit return to high-level athletic participation. LEVEL OF EVIDENCE Level IV.
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Kootstra TJ, van Leeuwen WF, Chen N, Ring D. Variation in Repair of the Triangular Fibrocartilage Complex. J Wrist Surg 2018; 7:243-246. [PMID: 29922502 PMCID: PMC6005778 DOI: 10.1055/s-0038-1625953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
Background There is controversy regarding the value of repair of the triangular fibrocartilage complex (TFCC). Given that an acute tear of the TFCC associated with a displaced distal radius fracture uncommonly benefits from repair, the role of repair in other settings is uncertain. Our impression is that TFCC repair is highly variable from surgeon-to-surgeon. Purpose The purpose of this study is to determine the rate of TFCC repair in patients who had a magnetic resonance imaging (MRI) scan of the wrist obtained for ulnar-sided wrist pain, and that showed signal changes in the TFCC. We tested the primary null hypothesis that there are no demographic or surgeon factors associated with repair of the TFCC. Patients and Methods Three hundred and ninety-four patients with ulnar-sided wrist pain and an MRI scan showing changes in the TFCC were included in this retrospective study. No patients had instability of the distal radioulnar joint (DRUJ) recorded in the medical record. Surgical repair of TFCC tears was used as the primary outcome during statistical analysis to identify factors associated with repair. Results Out of 394 (6%), 25 patients underwent TFCC repair. We found that 10% of the treating surgeons (4 out of 41) performed 80% of the procedures (20 out of 25). Patients who discerned a trauma prior to their symptoms and patients whose MRI showed signal changes primarily in the ulnar portion of the TFCC were more likely to have surgical repair. Conclusion We found that the rate of TFCC repair varies substantially from surgeon-to-surgeon. The observation that repair is more likely to happen when patients perceive themselves as injured suggests that perception of injury affects how patients and surgeons consider treatment options. To help avoid surgeries based on surgeon bias or patient misperception, we suggest studying the effect of tools that provide simple, balanced, dispassionate, and empowering information (e.g., decision aids) that can limit surgeon-to-surgeon variation. Level of Evidence Level IV.
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Affiliation(s)
- Thomas J.M. Kootstra
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wouter F. van Leeuwen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Soreide E, Haugstvedt JR, Husby T. Arthroscopic Assisted Resection of Triangular Fibrocartilage Complex Lesions: A 19-Year Follow-up. Hand (N Y) 2018; 13:325-330. [PMID: 28511611 PMCID: PMC5987974 DOI: 10.1177/1558944717708029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study assesses long-term functional and subjective outcomes following arthroscopic assisted resection of lesions of the triangular fibrocartilage complex (TFCC). METHODS Functional and subjective outcomes were assessed based on review of patient charts for patient demographic characteristics, comprehensive clinical evaluation, obtained radiographs, and patient-reported questionnaires. RESULTS Fifteen patients, of whom 9 were female, and 10 dominant wrists, were included in this study. Median age was 60 (range, 37-73) years, and median duration of follow-up was 19 (range, 18-21) years. Median Mayo Wrist Score was 85 (range, 45-100). Four patients scored excellent, 7 good, 3 fair, and 1 poor result according to the Modified Mayo Wrist Score. Median Quick Disabilities of the Arm, Shoulder and Arm was 20 (range, 0-45) and Patient-Rated Wrist and Hand Evaluation was 8 (range, 0-61). Patients reported high rate for satisfaction and low rate for pain. All patients presented intact stability of the distal radioulnar joint. CONCLUSIONS This study demonstrates persisting satisfactory subjective and functional outcomes for patients following arthroscopic assisted resection for lesions of the TFCC at 19 years of follow-up. Arthroscopically assisted resection of selected TFCC lesions seems to be both a safe and efficient procedure.
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Affiliation(s)
- Endre Soreide
- Oslo University Hospital, Ullevål, Norway,Endre Soreide, Department of Orthopedic Surgery, Oslo University Hospital, Ullevål, PO Box 4956 Nydalen, 0424 Oslo, Norway.
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Schmidle G, Kastenberger T, Arora R. Time-Dependent Recovery of Outcome Parameters in Ulnar Shortening for Positive Ulnar Variance: A Prospective Case Series. Hand (N Y) 2018; 13:215-222. [PMID: 28391754 PMCID: PMC5950970 DOI: 10.1177/1558944717702465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND This study evaluates the results of ulnar shortening using the ulna osteotomy locking plate system (UOL; I.T.S. GmbH, Graz, Austria) with special regard to the time-dependent recovery of subjective and objective outcome parameters and surgeons' experiences. METHODS Ulnar shortening using the UOL was performed on 11 patients (3 men, 8 women) with an average age of 47 ± 19.6 years. Range of motion (ROM) and grip strength were compared with the contralateral hand. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) and the Patient Rated Wrist Evaluation (PRWE) survey for subjective outcomes. Ulnar variance and bony union were assessed using conventional wrist radiographs. The surgeons evaluated intraoperative handling through a standardized feedback form. RESULTS ROM improved and grip strength increased significantly between preoperative values and final follow-up. Flexion and supination improved significantly between weeks 8 and 12 and grip strength from week 8 onward. Patient-rated outcomes changed significantly with a final DASH score of 14.2 ± 12.4 and a PRWE score of 24.3 ± 17.0. Pain levels improved significantly with no pain at rest and a mean VAS of 0.8 ± 1.2 during activity. The average amount of shortening was 4.0 ± 1.9 mm with a final ulnar variance of 0.2 ± 1.8 mm. All osteotomies healed with 2 cases of delayed union. CONCLUSIONS In ulnar shortening with the UOL, wrist function recovered after an initial decrease from week 8 onward. Subjective outcome parameters showed early recovery and improved continuously over time.
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Affiliation(s)
- Gernot Schmidle
- Medical University of Innsbruck, Austria
- Gernot Schmidle, Division of Hand Surgery, Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Oh WT, Kang HJ, Chun YM, Koh IH, An HMS, Choi YR. Arthroscopic Wafer Procedure Versus Ulnar Shortening Osteotomy as a Surgical Treatment for Idiopathic Ulnar Impaction Syndrome. Arthroscopy 2018; 34:421-430. [PMID: 29225020 DOI: 10.1016/j.arthro.2017.08.306] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiologic outcomes and complication rates of the arthroscopic wafer procedure (AWP) and ulnar shortening osteotomy (USO) for idiopathic ulnar impaction syndrome (UIS). METHODS From May 2009 to June 2014, 42 patients who were aged 45 years or older with idiopathic UIS underwent either the AWP or USO under the following identical surgical indications: (1) less than 4 mm of positive ulnar variance, (2) Palmer classification 2C or 2D lesion of the triangular fibrocartilage complex, (3) stable distal radioulnar joint (DRUJ) and/or lunotriquetral joint, and (4) no evidence of osteoarthritis of the DRUJ or ulnocarpal joint. The patient assignment was not randomized. Were used a visual analog scale for ulnar wrist pain; grip strength; range of motion; the Mayo Wrist Score (MWS); and the Disabilities of the Arm, Shoulder and Hand (DASH) score at 3, 6, 12, and 24 months after surgery to compare clinical outcomes. Ulnar variance, cystic changes of the lunate and triquetrum, and DRUJ arthritis on radiographs and operation-related complications were compared. RESULTS This study evaluated 19 patients after the AWP and 23 patients after USO. At 3 months, the AWP produced significantly better outcomes than USO regarding grip strength (79.6% ± 14.3% vs 62.7% ± 12.6%, P < .001), MWS (81.8 ± 7.9 points vs 71.3 ± 14.2 points, P = .005), and DASH score (19.4 ± 8.4 vs 31.5 ± 14.0, P = .001); clinical outcomes were similar at 6, 12, and 24 months. The complication rates were 34.8% for USO and 10.5% for the AWP; complications included DRUJ arthritis (n = 4), implant irritation (n = 6), and refracture after implant removal (n = 2) in the USO group and secondary surgery (n = 1) and tendinopathy (n = 1) in the AWP group. CONCLUSIONS The AWP and USO for idiopathic UIS with subtle positive ulnar variance achieved similar clinical and radiologic outcomes at 2 years after surgery. However, compared with USO, the AWP showed lower complication rates and better grip strength, MWS values, and DASH scores at 3 months after surgery. LEVEL OF EVIDENCE Level III, comparative trial.
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Affiliation(s)
- Won-Taek Oh
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il-Hyun Koh
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Mo-Su An
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Radiological degenerative changes in the distal radioulnar joint after ulnar shortening osteotomy in patients with idiopathic ulnar impaction syndrome: Analysis of factors affecting degenerative lesions. J Orthop Sci 2017; 22:1042-1048. [PMID: 28709834 DOI: 10.1016/j.jos.2017.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/04/2017] [Accepted: 06/28/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify factors influencing overall radiologic changes in the distal radioulnar joint after ulnar shortening osteotomy (USO) in patients with idiopathic ulnar impaction syndrome. MATERIALS AND METHODS A total of 310 patients who had undergone USO between May 2007 and December 2013 were included in this retrospective case-control study. The patients were classified into two groups (with or without radiologic findings of new arthritic changes), after which the following factors were analyzed: 1) demographic factors; 2) radiologic aspects, including ulnar variance (UV), morphological DRUJ type (classified according to Tolat et al.), and union period after USO; and 3) operative aspects, including the triangular fibrocartilage complex degeneration type, use of a parallel double-blade saw, type of plate used for fixation, and plate position on the volar or dorsal ulnar surface. RESULTS Group 1 (no arthritic changes) consisted of 243 patients, whereas Group 2 (arthritic changes) consisted of 67 patients. Univariate and multivariate analyses showed that the presence of lunate cystic changes, amount of shortening, and the union period were significantly associated with newly developed arthritic changes in the distal radioulnar joint (DRUJ) after USO. The morphological DRUJ type was not a significant factor. Arthritic changes were significantly more prevalent in patients with a shortening amount >4.5 mm and a union period <3.25 months. CONCLUSIONS Radiologic arthritic changes after USO, were associated with the presence of cystic changes in the lunate, a shortening amount (>4.5 mm), and early bony union (<3.25 months). TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic level III.
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Ross M, Wiemann M, Peters SE, Benson R, Couzens GB. The influence of cartilage thickness at the sigmoid notch on inclination at the distal radioulnar joint. Bone Joint J 2017; 99-B:369-375. [PMID: 28249978 DOI: 10.1302/0301-620x.99b3.38051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/08/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were: firstly, to investigate the influence of the thickness of cartilage at the sigmoid notch on the inclination of the distal radioulnar joint (DRUJ), and secondly, to compare the sensitivity and specificity of MRI with plain radiographs for the assessment of the inclination of the articular surface of the DRUJ in the coronal plane. PATIENTS AND METHODS Contemporaneous MRI images and radiographs of 100 wrists from 98 asymptomatic patients (mean age 43 years, (16 to 67); 52 male, 53%) with no history of a fracture involving the wrist or surgery to the wrist, were reviewed. The thickness of the cartilage at the sigmoid notch, inclination of the DRUJ and Tolat Type of each DRUJ were determined. RESULTS The assessment using MRI scans and cortical bone correlated well with radiographs, with a kappa value of 0.83. The mean difference between the inclination using the cortex and cartilage on MRI scans was 12°, leading to a change of Tolat type of inclination in 66% of wrists. No reverse oblique (Type 3) inclinations were found when using the cartilage to assess inclination. CONCLUSION These data revealed that when measuring the inclination of the DRUJ using cartilage, reverse oblique inclinations might not exist. The data suggest that performing an ulna shortening osteotomy might be reasonable even in distal radioulnar joints where the plain radiographic appearance suggests an unfavourable reverse oblique inclination in the coronal plane. We recommend using MRI to validate radiographs in those that appear to be reverse oblique (Tolat Type 3), as the true inclination might be different, thereby removing one possible contraindication to ulnar shortening. Cite this article: Bone Joint J 2017;99-B:369-75.
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Affiliation(s)
- M Ross
- Brisbane Hand and Upper Limb Research Institute, 9/259 Wickham Tce, Brisbane, Queensland, 4000, Australia
| | - M Wiemann
- Department of Foot and Ankle Surgery, Rhoen-Klinikum, Bad Neustadt, Germany
| | - S E Peters
- Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - R Benson
- Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent TN2 4QJ, UK
| | - G B Couzens
- Brisbane Hand and Upper Limb Research Institute, 9/259 Wickham Terrace, Brisbane QLD 4000, Australia
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Papatheodorou LK, Sotereanos DG. Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome. JBJS Essent Surg Tech 2017; 7:e3. [PMID: 30233938 DOI: 10.2106/jbjs.st.16.00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction The step-cut ulnar shortening osteotomy for the treatment of ulnar impaction syndrome is a safe, reliable, and less expensive technique that uses a 7-hole 3.5-mm standard neutralization plate and a lag screw for fixation, thus avoiding the need for the special instrumentation that other ulnar shortening techniques require. Indications & Contraindications Step 1 Preoperative Planning Perform a physical examination and obtain imaging studies to identify all associated abnormalities. Step 2 Wrist Arthroscopy Video 1 Verify the diagnosis of ulnar impaction syndrome and treat concurrent intra-articular abnormalities. Step 3 Incision for the Ulnar Shortening Osteotomy Video 2 Make a longitudinal skin incision along the distal third of the ulna. Step 4 Design the Step-Cut Ulnar Shortening Osteotomy Video 2 Design the step-cut ulnar shortening osteotomy. Step 5 Perform the Step-Cut Ulnar Shortening Osteotomy Video 2 Create the step-cut ulnar shortening osteotomy using an oscillating saw. Step 6 Fixation of the Osteotomy Video 3 Fix the osteotomy with a lag screw and volar plate. Step 7 Wound Closure Meticulously close the wound in layers. Step 8 Postoperative Care Protect the affected arm for the first 6 weeks. Results In our original study, 164 patients with symptomatic ulnar impaction syndrome were treated with a step-cut ulnar shortening osteotomy using a volar 3.5-mm standard neutralization plate and a lag screw14. Pitfalls & Challenges
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Affiliation(s)
| | - Dean G Sotereanos
- Orthopaedic Specialists-UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Greybe D, Boland MR, Wu T, Mithraratne K. A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33:e02790. [PMID: 27021471 DOI: 10.1002/cnm.2790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 03/14/2016] [Accepted: 03/19/2016] [Indexed: 06/05/2023]
Abstract
Ulnocarpal impaction syndrome involves excessive loading of the ulnocarpal joint. Ulnar shortening osteotomies are an effective way to reduce ulnocarpal loading but alter contact mechanics at the distal radioulnar joint (DRUJ). This study used a computational model to investigate the relationship between ulnar length and DRUJ mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The length of the ulna bone model was increased and decreased up to 5 mm in 1 mm increments. A computational model was used to predict joint contact at the DRUJ for each ulnar length. Lengthening the ulna caused a slight decrease in DRUJ contact pressure, with a more substantial decrease in contact area. Shortening the ulna caused a substantial increase in contact area, with a smaller increase in DRUJ contact pressure. The location of contact on the radial sigmoid notch changed with 2 mm lengthening and 3 mm shortening. The results of this study demonstrate the sensitivity of DRUJ contact to ulnar length changes, which may explain the DRUJ cartilage degeneration that often follows ulnar osteotomies. The joint contact model implemented in this study allowed the relationship between ulnar length and DRUJ contact to be examined systematically, in a way that is difficult to achieve through cadaveric experimentation. The results confirmed published experimental data showing an increased DRUJ contact pressure with ulnar shortening. It is important that clinicians consider the influence of ulnar osteotomies, not only on ulnocarpal loading but also on DRUJ mechanics. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Desney Greybe
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Michael R Boland
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim Wu
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kumar Mithraratne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Papatheodorou LK, Baratz ME, Bougioukli S, Ruby T, Weiser RW, Sotereanos DG. Long-Term Outcome of Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome. J Bone Joint Surg Am 2016; 98:1814-1820. [PMID: 27807114 DOI: 10.2106/jbjs.15.01111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extra-articular ulnar shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive. The purpose of this study was to evaluate the outcome of step-cut ulnar shortening osteotomy without special jigs for ulnar impaction syndrome. METHODS A retrospective study of 164 consecutive patients who underwent step-cut ulnar shortening osteotomy between 2000 and 2010 was performed. The long arm of the step-cut osteotomy was oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5-mm standard neutralization plate and a lag screw. The goal of the osteotomy was to reduce ulnar variance, which was assessed in all patients with pronated grip-view radiographs preoperatively and postoperatively. Preoperative ulnar variance ranged from +1 to +6 mm. RESULTS All patients were followed for at least 24 months. Union of the osteotomy site was achieved at a mean of 8.2 weeks. The union rate was 98.8%. There were 2 cases of nonunion, which required additional surgery. The mean postoperative ulnar variance was +0.2 mm (range, -1 to +1.5 mm) after a mean overall ulnar shortening of 2.5 mm. All patients returned to their previous work, in a mean of 4 months. The plate was removed from 12 patients because of plate-related symptoms. No other complications were encountered. CONCLUSIONS The step-cut ulnar shortening osteotomy provides ample bone-to-bone contact and simplifies control of rotation. Stable internal fixation with standard techniques allowed an early return to functional activities. Palmar placement of the plate diminishes the need for plate removal. This is a simple and less expensive technique for ulnar shortening that does not require the use of special instrumentation in patients with ulnar impaction syndrome. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Mark E Baratz
- University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
| | - Sofia Bougioukli
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Tyler Ruby
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W Weiser
- University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
| | - Dean G Sotereanos
- University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
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Daneshvar P, Willing R, Pahuta M, Grewal R, King GJW. Osseous Anatomy of the Distal Radioulnar Joint: An Assessment Using 3-Dimensional Modeling and Clinical Implications. J Hand Surg Am 2016; 41:1071-1079. [PMID: 27663051 DOI: 10.1016/j.jhsa.2016.08.012] [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: 04/13/2015] [Revised: 08/09/2016] [Accepted: 08/17/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Using a novel technique, we assess and describe the distal radioulnar joint (DRUJ) anatomy. The purpose of this study was to provide the anatomic dimensions of the DRUJ and to evaluate contralateral symmetry. METHODS Computed tomography images of 100 cadaveric forearms were obtained. Three-dimensional models of the radius and ulna were generated and evaluated using 3-dimensional modeling software. Measurements of the radius of curvature of the sigmoid notch (SN) and ulnar head (UH), as well as the length of the SN and volar and dorsal lips were performed in the axial and coronal sequences. In addition, mid-coronal angular measurements were made of the SN and UH to quantify the obliquity of the DRUJ. All coronal measurements were performed with the forearm set to neutral rotation. RESULTS The average ulnar variance was -0.9 ± 1.8 mm. The radius of curvature of the UH (8.2 ± 1.3 mm) was markedly smaller than that of the SN (18.2 ± 8.5 mm). The length of the SN in coronal sequences increased from volar to dorsal by 65%. The mid-coronal angle (DRUJ obliquity) of the SN and UH measured 6.0 ± 9.9° and 18.0 ± 9.9°, respectively. A direct inverse correlation was demonstrated in the obliquity of the DRUJ and ulnar variance. All anatomic measurements were similar when comparing bilateral specimens. CONCLUSIONS The SN length tends to increase in size from volar to dorsal. Bilateral specimens from the same individual demonstrate similarities and can be cautiously used for comparison. CLINICAL RELEVANCE The relationships and measurements demonstrated in this study can be a guide when considering reconstructive procedures or dealing with complex fractures involving the DRUJ.
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Affiliation(s)
- Parham Daneshvar
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Ryan Willing
- Department of Engineering, Binghamton University, State University of New York, Binghamton, NY
| | - Markian Pahuta
- Department of Orthopaedics, University of Toronto, Toronto Western Hospital, Toronto
| | - Ruby Grewal
- Department of Orthopaedics, The Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
| | - Graham J W King
- Department of Orthopaedics, The Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
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Jungwirth-Weinberger A, Borbas P, Schweizer A, Nagy L. Influence of Plate Size and Design upon Healing of Ulna-Shortening Osteotomies. J Wrist Surg 2016; 5:284-289. [PMID: 27777819 PMCID: PMC5074826 DOI: 10.1055/s-0036-1582430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
Purpose Ulna-shortening osteotomy is one of the most established and most frequent operations in hand surgery. However, bone union is not always achieved and the use of plates implies potential risks and problems. The traditional points of criticism are the duration of bone healing, the incidence of nonunion, and the necessity of hardware removal due to the soft tissue irritation by the plate or the screws. These shortcomings have been addressed by an increasing standardization of the procedure and finally specific instruments and implants. The aim of this retrospective study was to compare a new LCP (locking compression plate) Ulna Osteotomy System 2.7 mm (Synthes, Paoli, PA) with the former 3.5-mm LCDCP (limited-contact dynamic compression plate) (Synthes) regarding consolidation, complications, and rate of plate removal. Methods To investigate the effect of an implant and technique specifically designed for this purpose, we have compared the course of healing and the result in 72 patients who have undergone ulnar shortening osteotomy using general instruments and applying a standard osteosynthesis plate (Synthes, 3.5-mm LCDCP) to a consecutive cohort of 40 patients who had ulnar shortening using the new dedicated ulna-shortening osteotomy system plate (Synthes, 2.7-mm LCP). Clinical and radiologic evaluation was performed 8 weeks, 3 months, 6 months, and 1 year postoperatively in all patients. Results The latter displayed shorter bone healing time, suggesting an advantage of an oblique osteotomy. There was no significant difference in rate of plate removal. Ultimate complication and consolidation rate was not different. Conclusion Using the new LCP 2.7 implant, time to consolidation was shorter and oblique osteotomies healed faster than transverse ones. However, in spite of the smaller plate, screws, and tapered design, the plate did not cause less local problems and failed to decrease the necessity of plate removal. Furthermore, the cost of the implant is higher than the LCDPC 3.5. Type of Study Retrospective comparative study. Therapeutic evidence Level III.
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Affiliation(s)
| | - Paul Borbas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Division of Hand Surgery, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Division of Hand Surgery, Department of Orthopedics, University of Zurich, Zurich, Switzerland
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DESHMUKH SC, SHANAHAN D, COULTHARD D. Distal Radioulnar Joint Incongruity After Shortening of the Ulna. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s0266-7681(00)80006-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coronal sections of the distal radioulnar joint (DRUJ) were studied in 13 preserved cadaveric wrists specimens before and after 2 mm of shortening of the ulna. The DRUJs were subclassified on the basis of the DRUJ angle and depth of the sigmoid notch. The changes in extent and location of area of contact and radioulnar separation were noted. Although reduction in area of contact occurred in every specimen and DRUJ type, the maximum radioulnar separation and reduction in area of contact occurred in the DRUJ type IB and IIB. This could be a possible factor producing point loading and subsequent occurrence of DRUJ remodelling in the long-term after shortening of the ulna.
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Affiliation(s)
- S. C. DESHMUKH
- From the University of Newcastle-upon-Tyne Medical School, Newcastle-upon-Tyne, UK
| | - D. SHANAHAN
- From the University of Newcastle-upon-Tyne Medical School, Newcastle-upon-Tyne, UK
| | - D. COULTHARD
- From the University of Newcastle-upon-Tyne Medical School, Newcastle-upon-Tyne, UK
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Chennagiri R, Burge P. Pre-Osteotomy Plate Application Technique for Ulnar Shortening. ACTA ACUST UNITED AC 2016; 29:453-7. [PMID: 15336748 DOI: 10.1016/j.jhsb.2004.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 04/07/2004] [Indexed: 11/27/2022]
Abstract
The self-compressing mode of the AO/ASIF LC-DC plate can be harnessed to close and compress modest osteotomy gaps that are created after provisional application of the plate with two screw holes on either side of the osteotomy. The oblique osteotomy cuts are made through 70% of the bone diameter and the actual osteotomy width is measured. After provisional plate application and removal, the cuts are completed and the plate is re-applied. Eccentric drilling of up to five holes of a 6-hole plate using the 3.5 mm universal drill guide allows closure and compression of osteotomy gaps of up to 4 mm. An interfragmentary screw is placed across the oblique osteotomy through the remaining hole. The technique is simple but requires careful planning and execution.
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Affiliation(s)
- R Chennagiri
- Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK
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Seo JB, Kim JP, Yi HS, Park KH. The Outcomes of Arthroscopic Repair Versus Debridement for Chronic Unstable Triangular Fibrocartilage Complex Tears in Patients Undergoing Ulnar-Shortening Osteotomy. J Hand Surg Am 2016; 41:615-23. [PMID: 27039349 DOI: 10.1016/j.jhsa.2016.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/24/2016] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare the results of arthroscopic peripheral repair (AR) and arthroscopic debridement (AD) for the treatment of chronic unstable triangular fibrocartilage complex (TFCC) tears in ulnar-positive patients undergoing ulnar-shortening osteotomy (USO). METHODS A total of 31 patients who underwent arthroscopic treatments combined with USO for unstable TFCC tears and were followed-up at a minimum of 24 months were included in this retrospective cohort study. Fifteen patients were treated with AR, and 16 patients were treated with AD while at the same time undergoing a USO. Outcome measures included wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, and overall outcomes according to the modified Mayo wrist scoring system. In addition, a stress test to assess distal radioulnar joint (DRUJ) stability was performed before and after surgery to compare the 2 cohorts. RESULTS Both respective cohorts showed significant improvements in grip strength and subjective scores at the final follow-up. Grip strength, DASH, and PRWE scores were better in the AR group than in the AD group. The recovery rate from DRUJ instability observed during the preoperative examination was superior in the AR group. CONCLUSIONS Both AD and AR of the TFCC combined with USO are reliable procedures with satisfactory clinical outcomes for unstable TFCC tears in ulnar-positive patients. However, AR of the TFCC is suggested if DRUJ stability is concomitantly compromised. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea; Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, Korea
| | - Jong-Pil Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea; Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, Korea.
| | - Hyung-Suk Yi
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea
| | - Kwang-Hee Park
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea
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Ulna-Shortening Osteotomy: Outcome and Repercussion of the Distal Radioulnar Joint Osteoarthritis. Plast Reconstr Surg 2015; 137:175-184. [PMID: 26710021 DOI: 10.1097/prs.0000000000001870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ulnocarpal impaction syndrome occurs mostly in patients with positive ulnar variance. Ulnar-shortening osteotomy is a commonly used method to correct it, but degenerative changes may appear in the distal radioulnar joint. The authors evaluated outcome after ulnar-shortening osteotomy, particularly the impact of distal radioulnar joint osteoarthritis. METHODS A 10-year study was performed of patients who underwent ulnar-shortening osteotomy. RESULTS Forty-six patients were available for clinical examination and radiography. Twenty-nine wrists showed worsening or new osteoarthritis. A difference of preulnar variance and resection was noted: 4.64 mm and 4.48 mm, respectively, in the osteoarthritis group versus 3.50 mm and 3.38 mm in the group without osteoarthitis. Comparison of patients with osteoarthritis revealed a significant limitation of range of motion in flexion-extension (p = 0.009) and pronosupination (p = 0.028): 102 degrees and 138 degrees, respectively, in the osteroarthritis group versus 124 degrees and 155 degreees in the group without osterarthritis. The type of distal radioulnar joint differed significantly (p = 0.038), with a predominance of type I in the osterarthritis group and type II in the group without osterarthritis. Functional outcome was significantly worse in the osterarthritis group versus the group without osteoarthritis concerning the Patient-Rated Wrist Evaluation score (39.07 versus 22.59, p = 0.031), the Quick Disabilities of the Arm, Shoulder, and Hand score (27.38 versus 19.59, p = 0.017), and the modified Gartland-Werley score (76.72 versus 85.14, p = 0.027). CONCLUSIONS Ulnar-shortening osteotomy modifies the congruence of the distal radioulnar joint, and the type I joint may be at increased risk of arthrosis. Osteoarthritis has a clinical impact, and the amount of ulnar shortening should be limited to what is needed to avoid altering the functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Canham CD, Schreck MJ, Maqsoodi N, Messing S, Olles M, Elfar JC. Distal Radioulnar Joint Reaction Force Following Ulnar Shortening: Diaphyseal Osteotomy Versus Wafer Resection. J Hand Surg Am 2015; 40:2206-12. [PMID: 26452758 PMCID: PMC5828165 DOI: 10.1016/j.jhsa.2015.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare how ulnar diaphyseal shortening and wafer resection affect distal radioulnar joint (DRUJ) joint reaction force (JRF) using a nondestructive method of measurement. Our hypothesis was that ulnar shortening osteotomy would increase DRUJ JRF more than wafer resection. METHODS Eight fresh-frozen human cadaveric upper limbs were obtained. Under fluoroscopic guidance, a threaded pin was inserted into the lateral radius orthogonal to the DRUJ and a second pin was placed in the medial ulna coaxial to the radial pin. Each limb was mounted onto a mechanical tensile testing machine and a distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Data sets were entered into a computer and a polynomial was generated and solved to determine the JRF. This process was repeated after ulnar diaphyseal osteotomy, ulnar re-lengthening, and ulnar wafer resection. The JRF was compared among the 4 conditions. RESULTS Average baseline DRUJ JRF for the 8 arms increased significantly after diaphyseal ulnar shortening osteotomy (7.2 vs 10.3 N). Average JRF after re-lengthening the ulna and wafer resection was 6.9 and 6.7 N, respectively. There were no differences in JRF among baseline, re-lengthened, and wafer resection conditions. CONCLUSIONS Distal radioulnar joint JRF increased significantly after ulnar diaphyseal shortening osteotomy and did not increase after ulnar wafer resection. CLINICAL RELEVANCE Diaphyseal ulnar shortening osteotomy increases DRUJ JRF, which may lead to DRUJ arthrosis.
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Affiliation(s)
- Colin D. Canham
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY,Rochester Institute of Technology/University of Rochester Orthopaedic Biomechanics Laboratory, Rochester, NY
| | - Michael J. Schreck
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY,Rochester Institute of Technology/University of Rochester Orthopaedic Biomechanics Laboratory, Rochester, NY
| | - Noorullah Maqsoodi
- Rochester Institute of Technology/University of Rochester Orthopaedic Biomechanics Laboratory, Rochester, NY,Department of Manufacturing and Mechanical Engineering Technology, Rochester Institute of Technology, Rochester, NY
| | - Susan Messing
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Mark Olles
- Rochester Institute of Technology/University of Rochester Orthopaedic Biomechanics Laboratory, Rochester, NY,Department of Manufacturing and Mechanical Engineering Technology, Rochester Institute of Technology, Rochester, NY
| | - John C. Elfar
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY,Rochester Institute of Technology/University of Rochester Orthopaedic Biomechanics Laboratory, Rochester, NY
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Hardware Location and Clinical Outcome in Ulna Shortening Osteotomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e549. [PMID: 26579355 PMCID: PMC4634186 DOI: 10.1097/gox.0000000000000521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/01/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED The purpose of this study was to investigate the influence of plate location during ulna shortening osteotomy on the incidence of hardware irritation and clinical outcome. METHODS Forty patients (17 women, 23 men; mean age, 47 years) who underwent a shortening osteotomy of the ulna due to idiopathic ulna impaction syndrome were examined after a mean of 36 months. All complications and secondary procedures were extracted from the patients' records. RESULTS The rate of hardware removal was higher in patients who had a dorsal placement of the plate in comparison with ulnar or palmar placements, although this difference was not statistically significant. Apart from hardware irritation, there were 4 nonunions, 1 secondary osteoarthritis of the distal radioulnar joint, and 1 case of chronic irritation of the dorsal branch of the ulnar nerve, which required secondary surgery. The incidence of secondary surgery other than hardware removal was not significantly related to the original location of the plate. CONCLUSIONS Secondary surgery after ulnar shortening osteotomy is common. However, we found no difference in clinical outcomes based on plate location.
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