Nonunion Rates Among Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome: A Systematic Review

Owens, Jessell M.; Compton, Jocelyn; Day, Molly A.; Glass, Natalie; Lawler, Ericka A.

doi:10.1016/j.jhsa.2018.08.018

Cited by 34 publications

(42 citation statements)

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“…Although USO does carry the risks of hardware irritation, malunion, and nonunion, the rates of these complications have decreased in recent years with improved implant design and surgical technique. 4 It remains reasonable to attempt arthroscopic repair in patients without evidence of ulnar impaction syndrome, with the understanding that a subset of patients may have persistent ulnar-sided symptoms following repair 5 and can still benefit from an ulnar shortening at that time. 6 The main limitation of this study, which the authors correctly acknowledge, is its small sample size, which was underpowered to detect meaningful differences in revision rates and outcomes.…”

mentioning

confidence: 99%

Editorial Commentary: Ulnar Variance Is Not the Sole Determinant of Arthroscopic Wrist Triangular Fibrocartilage Complex Repair Outcome: Considering the Forest From the Ulnar-Positive Tree

Whitlock

Ruch

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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When choosing the best treatment option for patients with tears of the triangular fibrocartilage complex, there are multiple patient factors that should be carefully considered. The role of ulnar variance is often overemphasized when attempting to predict the success of arthroscopic repair. In practice, variables such as the age of the patient and location and nature of the tear as traumatic or degenerative should primarily drive the decision between arthroscopic repair and primary ulnar-shortening osteotomy. Arthroscopic repair should generally be avoided in favor of ulnar-shortening osteotomy in patients with degenerative tears and evidence of ulnar impaction syndrome. However, for acute, traumatic, ulnar-sided tears in young patients, arthroscopic repair remains an effective treatment option regardless of ulnar variance.

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mentioning

confidence: 99%

Editorial Commentary: Ulnar Variance Is Not the Sole Determinant of Arthroscopic Wrist Triangular Fibrocartilage Complex Repair Outcome: Considering the Forest From the Ulnar-Positive Tree

Whitlock

Ruch

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The delayed union can cause symptoms and inhibit patients' daily living. In a recent systematic review, the overall rate of nonunion among all osteotomy techniques was 4.0% [8]. Since the rate of delayed union is much higher than that of nonunion after USO, a delayed union can be a more frequent problem for patients who underwent USO.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical outcomes of USO are also satisfactory [2,4,6,7]. Despite its good clinical outcomes, its critical shortcomings, including nonunion or delayed union following the procedure, have variable incidence (0-12.7%) and remain unresolved [2,4,8].…”

Section: Introductionmentioning

confidence: 99%

Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy

et al. 2021

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Background Parallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO. Methods Between June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated. Results The baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy. Conclusions The minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.

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“…10 Suele ocurrir en casos de consolidación viciosa del radio distal, escisión de la cúpula radial, cierre prematuro de la fisis del radio, lesión de Essex-Lopresti, varianza cubital positiva congénita, deformidad de Madelung o en cualquier cuadro que cause un incremento en la longitud relativa del cúbito. 11 Como ya se mencionó en la sección de biomecánica, Friedman y Palmer demostraron que la ICC puede ser un cuadro dinámico, debido a los cambios intermitentes en la varianza cubital con las actividades de la vida cotidiana, en ocupaciones que requieren movimientos de prensión repetitiva y pronación del antebrazo. Así el cierre de puño con fuerza máxima en pronación resulta en un incremento en promedio de 1,95 mm en la varianza cubital.…”

Section: Definiciónunclassified

Impactación cubitocarpiana

Teruya

Altamirano

2021

Rev. Asoc. Arg. Ort. y Traumatol

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El objetivo de este artículo es actualizar los conocimientos sobre la impactación cubitocarpiana y su tratamiento. Estudios clásicos sobre la biomecánica del borde cubital de la muñeca han demostrado que los cambios milimétricos en la relación de longitud entre el cúbito y el radio alteran significativamente la transferencia de cargas entre los huesos del carpo, el radio y el cúbito. Así, un aumento relativo en la longitud del cúbito generará una carga excesiva sobre la articulación cubitocarpiana que producirá unespectro de cambios degenerativos progresivos en el domo cubital, el semilunar, el piramidal y el complejo del fibrocartílago triangular que finalizarán con artrosis cubitocarpiana y radiocubital distal. La impactación cubitocarpiana, en sus diversos estadios degenerativos, se puede tratar mediante osteotomías que buscan descomprimir la carga cubitocarpiana. Las osteotomías pueden ser extrarticulares o intrarticulares. Entre las extrarticulares, están las diafisarias, las metafisarias sin exposición articular (subcapitales) y las metafisarias distales con exposición articular y, entre las intrarticulares, la cirugía de resección en oblea (wafer), quereseca cartílago y hueso subcondral del domo cubital, y puede ser un procedimiento abierto o artroscópico. Si hay artrosis radiocubital distal, solo se podrá tratar con cirugías de rescate, como Darrach, Sauvé-Kapandji, Bowers, o una prótesis radiocubital distal. Estas técnicas de osteotomía se han analizado detalladamente para lograr definir sus ventajas y desventajas. Finalmente se propone una forma de tipificar la impactación cubitocarpiana, cuyo objetivo es orientar al lector hacia el mejor tratamiento posible, avalado por la bibliografía actual.

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Nonunion Rates Among Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome: A Systematic Review

Cited by 34 publications

References 40 publications

Editorial Commentary: Ulnar Variance Is Not the Sole Determinant of Arthroscopic Wrist Triangular Fibrocartilage Complex Repair Outcome: Considering the Forest From the Ulnar-Positive Tree

Editorial Commentary: Ulnar Variance Is Not the Sole Determinant of Arthroscopic Wrist Triangular Fibrocartilage Complex Repair Outcome: Considering the Forest From the Ulnar-Positive Tree

Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy

Impactación cubitocarpiana

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