Metaphyseal Ulnar Shortening Osteotomy for the Treatment of Ulnocarpal Abutment Syndrome Using Distal Ulna Hook Plate: Case Series

Nuñez, Fiesky A.; Barnwell, Jonathan; Li, Zhongyu

doi:10.1016/j.jhsa.2012.04.034

Cited by 22 publications

(24 citation statements)

References 17 publications

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“…It has also been hypothesized that healing might be faster and may be more reliable in metaphyseal than in diaphyseal osteotomies. 11 Nunez et al 19 used a metaphyseal ulnar shortening osteotomy in six patients and documented no nonunion.…”

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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“…Forty-one patients (59%) had classic diaphyseal osteotomy: 22 with the Trimed ulnar shortening system (Trimed Inc., Santa Clarita, CA), 14 with the Acumed ulnar shortening system (Acumed LLC, Hillsboro, OR), and 5 osteotomies had transverse freehand osteotomy and fixed with a Synthes 2.7 mm LCP (locking compression plate; DePuy-Synthes, West Chester, PA). Twenty-eight patients (41%) had metaphyseal osteotomy as previously described by Nunez et al, 26 Seventeen patients had patient-reported and EMR (electronic medical record)-confirmed use of daily opioid medications at the time of surgery (25%); 8 patients were prescribed opioids for chronic wrist pain, 5 patients for chronic back pain, 3 patients for chronic knee pain, and 3 patients for a combination of degenerative conditions including knee AVN, hip AVN, sequelae of pelvic fractures, and chronic pain syndrome of multiple sites. Complete demographic information is summarized in ►Table 1.…”

Section: Cohortmentioning

confidence: 99%

Determinants of Pain and Predictors of Pain Relief after Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

et al. 2019

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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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“…25,26 More recently, distal metaphyseal ulnar-shortening osteotomy has been reported in several studies with promising results. [27][28][29][30] Metaphyseal cancellous bone has richer blood supply and is less resistant to osteotomy compared with diaphyseal bone. This results in less bone necrosis from heating, thereby reducing the risk of nonunion and the time to return to unrestricted motion.…”

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confidence: 99%

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

et al. 2019

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Purpose To compare the biomechanical characteristics between diaphyseal and metaphyseal ulnar-shortening osteotomy with respect to (1) maximal shortening achieved at each osteotomy site and (2) force required to achieve shortening at each site. Methods Nine fresh frozen cadaveric upper extremities were affixed through the proximal ulna to a wooden surgical board. A metaphyseal 20-mm bone wedge was resected from the distal ulna and sequential shortening was performed. A load cell was attached to a distal post that was clamped to the surgical board and used to measure the force required for each sequential 5-mm of shortening until maximal shortening was achieved. The resected bone was reinserted, and plate fixation was used to restore normal anatomy. A 20-mm diaphyseal osteotomy was performed, and force measurements were recorded in the same manner with (1) interosseous membrane intact, (2) central band released, and (3) extensive interosseous membrane and muscular attachments released. Results Metaphyseal osteotomy allowed greater maximal shortening than diaphyseal osteotomy with the interosseous membrane intact and with central band release but similar shortening when extensive interosseous membrane and muscle release was performed. Force at maximal shortening was similar between metaphyseal and diaphyseal osteotomy. Sequential soft tissue release at the diaphysis allowed for increased shortening with slightly decreased shortening force with sequential release. Conclusion Metaphyseal ulnar osteotomy allows greater maximal shortening but requires similar force compared with diaphyseal osteotomy. Sequential release of the interosseous membrane permits increased shortening at the diaphysis but requires extensive soft tissue release. Clinical Relevance Both sites of osteotomy can achieve sufficient shortening to decompress the ulnocarpal joint for most cases of ulnar impaction syndrome. The greater shortening from metaphyseal ulnar osteotomy may be reserved for severe cases of shortening, especially after distal radius malunion or in the setting of distal radius growth arrest in the pediatric population. Level of Evidence This is a Level V, basic science study.

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Metaphyseal Ulnar Shortening Osteotomy for the Treatment of Ulnocarpal Abutment Syndrome Using Distal Ulna Hook Plate: Case Series

Cited by 22 publications

References 17 publications

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

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

Determinants of Pain and Predictors of Pain Relief after Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

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