Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius

Stirling, Paul; Oliver, William W.; Tan, Huai Ling; Brown, Iain; Oliver, Christopher William; McQueen, Margaret M.; Molyneux, Samuel G; Duckworth, Andrew D.

doi:10.1302/0301-620x.102b11.bjj-2020-0848.r3

Cited by 10 publications

(12 citation statements)

References 51 publications

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“…They concluded that corrective osteotomy for distal radius malunion provides good functional outcomes. In addition, it is associated with high levels of patient satisfaction [14]. Similarly, good to excellent functional outcomes were observed in 95.6% of patients of the current study.…”

Section: Andreasson Et Al Reported the Outcome Of Correctivesupporting

confidence: 72%

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Shariatzade

Mazhar

Barkam

et al. 2021

J. Res. Orthop. Sci.

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Background: Optimization of the corrective osteotomy for the treatment of distal radius extra-articular ‎ ‎malunion is an ‎ongoing project‎‏. Objectives: In this study, ‏we aimed to evaluate the outcome of corrective osteotomy ‎with K-wire fixation in the treatment of patients with symptomatic distal radius extra-articular malunion.‎ Patients & Methods: Twenty-three patients with symptomatic distal radius extra-articular malunion, mean ‎age of ‎38.3±7.6‎‏ years‎, ‎and a mean follow‎-‎up of ‏‎34.4±11.3 months‎‏ were included‎. ‎Corrective osteotomy ‏was performed through a dorsal approach and using K‎-‎wire instead of the plate for the fixation ‏of the osteotomy site‎. ‎The outcome was assessed with radiographic measures including ‏ulnar ‎variance, radial tilt, radial inclination angle, radial height, and clinical measures including ‎wrist range of motion, the short form of Disabilities of the Arm, Shoulder, and ‎Hand (Quick-‎DASH), and the Modified Mayo Wrist Score (MMWS).‎ Results: Radiographic measures and wrist range of motion in all directions were significantly improved at the last follow-up. The mean final Quick-DASH score of the patients was 16.3±8. The mean final MMWS was 92.2±13.5. According to the MMWS, 9 (39.1%) patients had an excellent function, 13 (56.5%) patients had a good function, and one (4.4%) patient had a fair function. Radiographic union was observed in all wrists within an average period of 10.2±4 weeks. No postoperative complication was recorded. Conclusion: Since K-wire fixation is less expensive, requires smaller incision, and provides acceptable radiologic and clinical outcomes, it could be regarded as a good alternative for plate fixation in corrective osteotomy for distal radius extra-articular malunion.

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Section: Andreasson Et Al Reported the Outcome Of Correctivesupporting

confidence: 72%

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Shariatzade

Mazhar

Barkam

et al. 2021

J. Res. Orthop. Sci.

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“…Stirling et al. investigated the patient-reported outcome following corrective osteotomy of the distal radius and also reported favorable results [ 45 ]. For patients with severe concomitant wrist instability, other treatment modalities may be necessary; however, this was outside the scope of this study.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

Shaer

Blomme²,

Sluijter³

et al. 2022

J Orthop Traumatol

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Background Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence Therapeutic III.

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“…Despite the observed improvement after USO, the mean long-term PRWHE score (mean = 19) still was worse than the age-standardized reference ranges from the general Dutch population (mean = 8). 31 This finding was also observed after a late follow-up of patients who underwent corrective osteotomy of the distal radius 32 or patients who underwent open repair of the triangular fibrocartilage complex (TFCC). 33 These data may be important for managing treatment expectations.…”

Section: Discussionmentioning

confidence: 76%

Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years

Teunissen¹,

Oest

Selles

et al. 2022

Bone & Joint Open

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Aims The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. Methods Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. Results Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). Conclusion Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.

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Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius

Cited by 10 publications

References 51 publications

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years

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