Precision oblique osteotomy for shortening of the ulna

Rayhack, John M.; Gasser, Seth I.; Latta, Loren L.; Ouellette, Elizabeth Anne; Milne, Edward

doi:10.1016/0363-5023(93)90065-b

Cited by 116 publications

(110 citation statements)

References 7 publications

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“…All but one case in our cohort had an oblique osteotomy (including the case that went on to nonunion) and the majority underwent fixation with the Rayhack system. There have been reports suggesting these techniques decrease the rates of delayed and nonunion [3,14]. Two of our patients required subsequent total wrist arthrodesis.…”

Section: Discussionmentioning

confidence: 94%

Mid-Term Results Following Ulna Shortening Osteotomy

et al. 2013

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Background: Successful short-term results of diaphyseal ulna shortening osteotomy are documented in both idiopathic and post-traumatic ulnar impaction. Questions/Purposes: The purpose of this study was to evaluate the mid-term outcomes of ulnar shortening osteotomy with respect to radiographic assessment of corrected alignment and healing as well as patient satisfaction, pain, and function assessed using the Disability of the Arm, Shoulder, and Hand (DASH) score. Patients and Methods: This retrospective case series included follow-up of 33 patients with ulnar impaction syndrome following ulna shortening osteotomy at a minimum of 5 years. Patient-rated outcomes included satisfaction, pain assessment, and DASH score. Pre-and postoperative radiographs were reviewed to quantify ulnar variance and osteotomy union rates. Subsequent operations were also recorded. Results: Average followup was 10 years (range, 5-20 years). Eighty-eight percent of patients reported they were either satisfied or very satisfied with the procedure and 91% reported they would have the same procedure again. Average pain rating was 2 out of 10 at final follow-up. The mean DASH score was 11 (range, 0-39). Removal of hardware was performed in 10 patients (30%). The overall rate of reoperation was 45%. Conclusions: Ulna shortening osteotomy yields reliable midterm satisfaction and pain relief in patients with idiopathic and post-traumatic ulnar impaction syndrome. Reoperation is frequent. Consistent with results of short-term follow-up, plate irritation requiring removal remains the most common cause for reoperation over time.

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Section: Discussionmentioning

confidence: 94%

Mid-Term Results Following Ulna Shortening Osteotomy

et al. 2013

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“…In rationalizing the need for an improved ulna shortening system, Rayhack et al noted excessive healing times and risk of nonunion, imprecise cuts, and "struggles with fixing the osteotomy" as all problems with free-hand techniques [21]. Even using a compression jig, his group reported an average healing time of 21 weeks and one nonunion in 23 osteotomies (which improved to 11 weeks for 17 osteotomies once he switched from a transverse to an oblique cutting angle) [21]. Mizuseki et al [18] introduced their own osteotomy system noting their own previous experience with nonunion, angulation, and imprecise shortening.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

Isaacs¹,

Howard

Gulkin³

2009

Hand (New York, N,Y.)

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Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p<0.05) and average patient satisfaction was 8.7. DASH and PRWE scores improved at three month follow-up (p<0.05). Osteotomy healing time averaged 10.3 weeks, and there were no nonunions. Average discomfort associated with palpation of the plate at final follow-up was 3.3 (using VOS), and one patient requested removal of the hardware. In this short-term follow-up study, the assessed ulna shortening system appears effective and, in general, well tolerated.

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“…La técnica, originalmente descripta por Milch 34 en 1941, ha sido modificada desde entonces [35][36][37][38] . Las ventajas de esta técnica incluyen la descompresión efectiva del aspecto cubital de la muñeca, tensado de los ligamentos extrínsecos cubito-carpianos, promoviendo una mayor estabilidad semiluno-piramidal.…”

Section: A Choqueunclassified

“…El tiempo promedio para la consolidación, en diferentes estudios realizados, varía de 7 a 21 semanas. Más del 95% de los pacientes en distintas series publicadas, tiene resultados buenos o excelentes [35][36][37][40][41][42][43] . Las posibles complicaciones incluyen hasta un 4% porcentaje de pseudoartrosis, dolor con el movimiento, necesidad de extraer la placa de osteosíntesis y cambio en la configuración articular que conlleve a la incongruencia de la ARCD.…”

Section: A Choqueunclassified

La articulación radiocubital distal. Anatomía, patología y tratamiento

Özer

Casado

Scheker

2006

Rev Iberoam Cir Mano

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L a rotación del antebrazo depende de una normal relación anatómica en las articulaciones radiocubital, distal y proximal, la membrana interósea, y la conformación anatómica de los huesos del antebrazo. Las lesiones de alguna de estas estructuras resulta en dolor, disminución de fuerza, limitación del movimiento y pérdida de la función del antebrazo. ANATOMÍA Y BIOMECÁNICAEl radio y el cúbito constituyen una articulación bicondilar, articulados proximal y distalmente en las articulaciones radio-cubitales. Ubicada entre ambas articulaciones se encuentra la membrana interósea que actúa como ligamento suspensorio, dando origen a los músculos flexores y extensores. La estabilidad de las articulaciones radiocubital proximal y distal, depende de gruesas y complejas estructuras ligamentarias, conocidas como el ligamento anular y el complejo del fibrocartílago triangular (CFCT), respectivamente.La articulación radio-cubital distal consiste en dos superficies articulares disímiles, la escotadura sigmoidea y la cabeza del cúbito. El contacto de estas dos superficies articulares varía del 80% de contacto, durante la posición neutra, al 10% o 20% durante la pronación y supinación máximas 1 . La articulación se encuentra estabilizada, fundamentalmente, por el CFCT 1 , el cual consiste en el fibrocartílago triangular (disco articular) 2 , los ligamentos radiocubital palmar y dorsal 3 , el menisco homó-logo 4 , y la vaina del cubital posterior 2 . Los ligamentos radiocubital palmar y dorsal, son los principales estabilizadores de esta articulación. Cada ligamento se halla constituido por una porción superficial y una porción profunda. Ambas porciones se originan en el cubito, la parte supeficial en la apófisis estiloides desde la base hasta la punta y la parte profunda en la fovea de la cabeza del cubito. Ambas porciones se insertan en la parte más distal de la fosa sigmoidea. Durante la supinación, la porción profunda del ligamento radiocubital palmar y la porción superficial del ligamento radiocubital dorsal se encuentran en tensión. Durante la pronación, la porción profunda del ligamento radiocubital dorsal y la porción superficial del ligamento radiocubital palmar son los que se hallan bajo tensión [3][4][5][6] . La región central (80%) del disco articular es avascular, en tanto que los ligamentos radiocubitales dorsal y palmar, como el 20% de la periferia del disco articular, presentan una rica vascularización por medio de ramas de la arteria interósea anterior, la arteria cubital, y las arterias medulares interóseas que penetran, a través de la cabeza cubital, en la región de la fó-vea articular 7 . Como resultado de este patrón

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Precision oblique osteotomy for shortening of the ulna

Cited by 116 publications

References 7 publications

Mid-Term Results Following Ulna Shortening Osteotomy

Mid-Term Results Following Ulna Shortening Osteotomy

A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

La articulación radiocubital distal. Anatomía, patología y tratamiento

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