Comparison of Compression Screw and Perpendicular Clamp in Ulnar Shortening Osteotomy

Martín, Daniel; Zlotolow, Dan A.; Russo, Stephanie A.; Kozin, Scott H.

doi:10.1016/j.jhsa.2014.04.045

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…7 Time to bony union was observed at a median of 10 weeks (range, 6-33 weeks) using a locking plate according to Schmidle et al 15 Force in compression using a perpendicular clamp showed significantly better results than using a traditional compression screw technique. 16 Smoking was proven as having a negative effect on bony union in ulnar shortening osteotomy, with a nonunion rate of 30% compared with nonsmokers. Chen et al found a mean union rate of 4.1 months in nonsmokers and 7.1 months in smokers.…”

Section: Discussionmentioning

confidence: 99%

Influence of Plate Size and Design upon Healing of Ulna-Shortening Osteotomies

et al. 2016

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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 ulnashortening 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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Section: Discussionmentioning

confidence: 99%

Influence of Plate Size and Design upon Healing of Ulna-Shortening Osteotomies

et al. 2016

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“…The reported rates of nonunion after ulnar shortening osteotomy are 13% to 18% for traditional AO plating techniques and 4% to 7% for ulnar shortening osteotomy plating systems, including custom cutting jigs and reduction devices. 1 In particular, Chen et al 3 reported that the mean times to union after ulnar shortening osteotomy were 7.1 months in smokers and 4.1 months in nonsmokers, and that smokers had increased potential for nonunion, which amounted to 30% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…U lnar shortening osteotomy is widely performed as the standard surgical treatment for ulnar impaction syndrome and has a high percentage of success for pain relief and recovery of function. 1,2 However, delayed union and nonunion of the osteotomy site remain the most concerning complications. In particular, smokers have a higher incidence of nonunion, which amounts to 30% of cases.…”

mentioning

confidence: 99%

“…To decrease the risk of nonunion and avoid secondary surgery for nonunion, various surgical procedures using an oblique or step-cut osteotomy and compression plating system with special compression devices have been introduced. 1,2 As a noninvasive locally effective procedure, the use of low-intensity pulsed ultrasound (LIPUS) has been indicated in various other cases of nonunion and in accelerated bone healing after ulnar shortening osteotomy. 4 Recently, as a noninvasive pharmacological systemic treatment for fracture healing or nonunion, teriparatide administration has been reported in several clinical studies.…”

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confidence: 99%

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Successful Bone Healing of Nonunion After Ulnar Shortening Osteotomy for Smokers Treated With Teriparatide

Uemura¹,

Okada²,

Yokoi³

et al. 2015

Orthopedics

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Ulnar shortening osteotomy is widely performed as the standard surgical treatment for ulnar impaction syndrome and has a high percentage of success for pain relief. However, delayed union and nonunion of the osteotomy site remain the most concerning complications. In particular, smokers have a higher incidence of nonunion, which amounts to 30% of cases. For the treatment of nonunion, secondary surgical interventions such as bone grafting will be necessary but are extremely challenging. Recently, teriparatide (recombinant human parathyroid hormone [PTH 1-34]) administration has been reported in several clinical studies as a noninvasive pharmacological systemic treatment for fracture healing or nonunion. The authors present 2 cases of smokers, a 62-year-old man and a 42-year-old woman, with nonunion after ulnar shortening osteotomy and fixation with 6-hole non-locking plate for ulnar impaction syndrome. For treatment of nonunion, noninvasive therapy with teriparatide (20-µg, subcutaneous injection) in addition to low-intensity pulsed ultrasound was underwent. In both cases, partial bone union began to be observed on radiographs after the first 4 weeks of teriparatide administration and successful bone healing without additional surgical interventions was achieved after 10 and 6 months of treatment with teriparatide, respectively. The current case reports showed that non-invasive combination therapy of teriparatide and low-intensity pulsed ultrasound were a possible alternative to surgical intervention. In the future, teriparatide therapy might be applied actively to patients who have risk factors for delayed union, such a heavy smoking habit, and are expected to experience nonunion after ulnar shortening osteotomy.

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“…Multiple commercially available systems maximize bony coaptation and compression, thereby promoting primary union. 9 The plate-and-screw construct and ulnar length are checked with minifluoroscopy before closure. The subcutaneous tissue and skin are closed with absorbable suture.…”

Section: Ulnar Shortening Osteotomymentioning

confidence: 99%