Mid-Term Results Following Ulna Shortening Osteotomy

Fufa, Duretti T.; Carlson, Michele G.; Calfee, Ryan P.; Sriram, Nandita; Gelberman, Richard H.; Weiland, Andrew J.

doi:10.1007/s11420-013-9371-7

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…should be positioned dorsoulnar ( Figure 5) that safely prevents soft tissue complications and painful impingement with the IOM potentially leading to loss of forearm rotation [51][52][53][69][70][71][72][73]. However, despite of correct performing USO accompanied with a correctly positioned plate, patient's disability is reported to be up to 19% after surgery, and so the postoperative course remains not always predictable [53,74].…”

Section: Discussionmentioning

confidence: 99%

“…However, despite of correct performing USO accompanied with a correctly positioned plate, patient's disability is reported to be up to 19% after surgery, and so the postoperative course remains not always predictable [53,74]. That can be based either on long duration of symptoms or occult painful osteoarthritis in DRUJ that does not always correlate with the radiographic findings which is well known from other joints such as the carpometacarpal joint of the thumb (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…UPV shorter than 2 mm), and also noted that wrist arthroscopy is associated with a complication rate of 6 % respectively [49,50]. Likewise, recent evidence suggests that ulnar shortening osteotomy (USO) accompanied with wrist arthroscopy does not always lead to satisfactory outcomes in patients with long duration of symptoms, and it does not confer any additional benefit over USO alone as well [40,[51][52][53]. Furthermore, evident UPV is considered to be contraindication for arthroscopy of the DRUJ [54].…”

Section: Discussionmentioning

confidence: 99%

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Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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“…For example, a review of the literature reveals an accepted range of immobilization from 2 to 8 weeks following ulnar shortening osteotomy for the treatment of ulnar impaction syndrome. 1,2,3,5 To investigate these differences, we designed a survey to gain insight into variations that exist in postoperative immobilization of the hand and wrist. The purpose of this study was to (1) report variations in the duration of immobilization for common hand surgery procedures and (2) to determine whether there is any correlation between surgeon's years of experience and duration of postoperative immobilization as has been observed at our institution.…”

Section: Introductionmentioning

confidence: 99%

Variations in Postoperative Immobilization Following Common Hand Surgery Procedures

Díaz

Ebramzadeh

Yao

2016

Hand (New York, N,Y.)

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Background:The aim was to investigate variations in the duration of postoperative immobilization for common hand surgery procedures and to determine whether there is any correlation between surgeon experience and duration of postoperative immobilization. Methods: An anonymous cross-sectional survey was sent to the American Society for Surgery of the Hand asking the following questions: (1) number of years in practice and (2) duration of immobilization for 16 common hand surgery procedures. A Pearson's correlation coefficient was used to determine correlations between surgeon experience and duration of immobilization. Box plots were created to display the distribution and variability in postoperative immobilization per procedure among surgeons. Results: A total of 1126 respondents completed the survey, yielding a response rate of 40%. Procedures with a greater average duration of immobilization demonstrated the greatest variability. The largest variability overall was observed in intercarpal ligament repair with the majority of responses distributed between 4 and 10 weeks of immobilization. The smallest variability was observed following De Quervain's release and Dupuytren's fasciectomy. Only small correlations between surgeon experience and duration of immobilization were observed. Specifically, all Pearson correlation coefficients were less than .20. Conclusions: This study supports the hypothesis that large variations exist in the duration of immobilization following common hand surgery procedures. Only small correlations were found between surgeon experience and average duration of immobilization. The study suggests that there is a lack of evidence to guide postoperative immobilization for common hand surgery procedures and that prolonged immobilization may not be necessary for certain hand procedures.

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“…Ulna-shortening osteotomy has become a popular treatment for a variety of ulnar-sided wrist disorders [1][2][3]. The prevalence of delayed union or nonunion following ulnarshortening osteotomy is a serious problem that cannot be ignored, especially in smokers [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Preservation of Corticoperiosteal Attachment on Bone Healing at Osteotomy Sites after Ulna-shortening Osteotomy

Hamada

Sairyo

Hibino

et al. 2014

Hand (New York, N,Y.)

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Background Although precise ulna-shortening osteotomy is popular, the procedure sometimes results in delayed union or nonunion. The periosteum including the inner cambium layer plays an important role in fracture healing. We tested the hypothesis that preservation of the corticoperiosteal attachment may accelerate healing at osteotomy sites after ulnashortening osteotomy. Methods We performed a chart review of 32 patients who underwent ulna-shortening osteotomy for ulnar impaction syndrome or triangular fibrocartilage complex tears in a retrospective single-surgeon series. Of the 32 cases, the periosteum was preserved in 21 osteotomies performed from April 2009 onwards (periosteum-preserved group) and not preserved in 11 osteotomies performed before April 2009 (control group). Following sugar tong immobilization, patients in both groups used a short wrist supporter during the first two postoperative weeks (POW) and up to at least four POW. Union of the osteotomy site was assessed at 2-week intervals using radiographs taken at three different projections until 12 POW and at 4-week intervals thereafter until 24 POW. Ulna shortening was performed using a transverse osteotomy cut with the aid of a commercially available compression device. Results All osteotomies achieved complete union except in one case in the control group. The mean interval to complete cortical union was 7.7 weeks in the periosteum-preserved group and 9.5 weeks in the control group. The corresponding mean times for endosteal union were 15.6 and 21.8 weeks. The periosteum-preserved group had reduced times for both types of union but only the endosteal union time was significantly different from the control group. Conclusions Preservation of the corticoperiosteal attachment significantly shortened the endosteal union time. Our results indicate that preservation of the periosteum may accelerate bone healing after ulna-shortening osteotomy.

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Mid-Term Results Following Ulna Shortening Osteotomy

Cited by 21 publications

References 20 publications

Variations in Postoperative Immobilization Following Common Hand Surgery Procedures

Effect of Preservation of Corticoperiosteal Attachment on Bone Healing at Osteotomy Sites after Ulna-shortening Osteotomy

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