Modified Step-Cut Osteotomy for Metacarpal and Phalangeal Rotational Deformity

Jawa, Andrew; Zucchini, Maura; Lauri, Guilio; Jupiter, Jesse B.

doi:10.1016/j.jhsa.2008.11.018

Cited by 29 publications

(6 citation statements)

References 12 publications

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“…5,10,13 The goal of surgical correction is the restoration of clinical function by correcting the anatomy. Different techniques for corrective osteotomies of metacarpal shaft malunions have been described, 13,17,46 but the correction is mostly performed at the apex of the deformity. However, for the correction of phalangeal malunions, it is debated whether an extra-anatomic metacarpal or an anatomic phalangeal osteotomy should be performed, and whether intra-articular malunions should be corrected intra-or extra-articularly.…”

Section: Introductionmentioning

confidence: 99%

Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy

Hirsiger

Schweizer

Miyake

et al. 2017

Hand (New York, N,Y.)

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BACKGROUND Surgical planning of corrective osteotomies is traditionally based on conventional radiographs and clinical findings. In the past 10 years, 3-dimensional (3D) preoperative planning approaches with patient-specific guides have been developed. However, the application of this technology to posttraumatic deformities of the metacarpals and phalangeal bones has not yet been investigated. Our goal was to evaluate the feasibility of the surgical application to the latter and to evaluate the extent and precision of correction. METHODS We present results of 6 patients (8 osteotomies) treated with phalangeal or metacarpal corrective osteotomy. Deformities were located in the third ray in 1, fourth ray in 3, and fifth ray in 4 cases. Six malunited metacarpal bones (1 intra-articular) and 2 deformed proximal phalanges were treated. Computer-based 3D preoperative planning using the contralateral hand as a template allowed the production of 3D-printed patient-specific guides that were used intraoperatively for navigation. The precision of the reduction was assessed using pre-and postoperative computed tomography by comparing the postoperative bone model with the preoperatively simulated osteotomy. Range of motion and grip strength were documented pre-and postoperatively. RESULTS The mean follow-up time was 6 months (range: 5-11 months). Rotational deformity was reduced from a mean of 10.0°(range: 7.2°-19.3°) preoperatively to 2.3°(range: 0.7°-3.7°) postoperatively, and translational incongruency decreased from a mean of 1.4 mm (range: 0.7-2.8 mm) to 0.4 mm (range: 0.1-0.9 mm). CONCLUSION Preliminary results indicate that a precise reduction for corrective osteotomies of metacarpal and phalangeal bones can be achieved by using 3D planning and patient-specific guides.

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Section: Introductionmentioning

confidence: 99%

Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy

Hirsiger

Schweizer

Miyake

et al. 2017

Hand (New York, N,Y.)

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“…Step cut osteotomies have also been described in the literature. However, they were devised to correct rotational deformities (Jawa et al, 2009;Manktelow and Mahoney, 1981;Pichora et al, 1991). In our patients, all 11 malunions with rotational deformity also had angulation, apparent shortening and painful grasp.…”

Section: Discussionmentioning

confidence: 90%

“…Various techniques have been described in the literature. However most of them need rigorous pre-operative planning, meticulous surgical technique, have a narrow margin for error and have a steep learning curve (Jawa et al, 2009;Manktelow and Mahoney, 1981;Pichora et al, 1991;Yong et al, 2007). Closing wedge osteotomies, though easy to perform, have inherent problems related to possible shortening and it can be difficult to control and compress the fragments during rigid internal fixation (Jupiter et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Corrective osteotomy for malunited metacarpal fractures: long-term results of a novel technique

Karuppaiah

Tahmassebi

Khakha

et al. 2015

J Hand Surg Eur Vol

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Symptomatic malunited metacarpal fractures can significantly affect hand function. We retrospectively reviewed the results of our technique of corrective osteotomy in 14 malunited metacarpal fractures (12 patients) with an average age of 30 years (range 18-49) from January 2005 to December 2011. The dominant hand was involved in nine patients and all except one were male. The malunited metacarpals demonstrated mean dorsal apex angulation of 43° (range 33°-72°) with apparent metacarpal shortening. All except three cases had rotational deformity. All patients underwent surgical correction of the deformity using our described technique of closing wedge osteotomy using temporary intramedullary K-wire and plate fixation. At a mean follow-up of 46 months (range 12-78), the DASH scores improved significantly (p < 0.001). All our patients scored 'excellent' according to the Büchler criteria and at final follow-up had returned to pre-injury work and sports activities. Our technique is safe, easily performed and can be adapted to correct a range of deformities. Level of evidence: Level IV.

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“…Step-cut osteotomies of diaphyseal bone have been successfully used for the treatment of pediatric supracondylar deformities, metacarpal and phalangeal rotational deformities, ulnar shortening, and nonunions of the radial and ulnar shafts. [21][22][23][24] A stepcut osteotomy of the humeral diaphysis can be an effective addition to plate fixation when addressing a nonunion of the humeral shaft unresponsive to initial surgical management. 24 The step-cut osteotomy creates ample surface area for boneto-bone contact.…”

Section: Discussionmentioning

confidence: 99%

Step-Cut Osteotomy for Recalcitrant Humeral Shaft Nonunion

Dailey¹,

Archdeacon²

2016

Orthopedics

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The majority of humeral shaft nonunions resolve following operative intervention; however, a small percentage will persist despite surgical efforts. These cases of persistent nonunion are frustrating for patients and challenging for orthopedic surgeons. The authors describe the use of a step-cut osteotomy of the humeral diaphysis coupled with neutralization plating and autologous bone grafting for the management of humeral shaft nonunions that were recalcitrant to initial surgical management. In the authors' experience, this technique has been a valuable adjunct for obtaining adequate reduction and subsequent union in these complex cases. [Orthopedics. 2016; 39(3):e587-e591.].

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Modified Step-Cut Osteotomy for Metacarpal and Phalangeal Rotational Deformity

Cited by 29 publications

References 12 publications

Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy

Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy

Corrective osteotomy for malunited metacarpal fractures: long-term results of a novel technique

Step-Cut Osteotomy for Recalcitrant Humeral Shaft Nonunion

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