Reply to the letter to the editor: shortening osteotomy of the proximal radius

Disadvantages of having a shortening of the proximal radius

“…With great interest we have read the article ‘ Radial shortening osteotomy reduces radiocapitellar contact pressures while preserving valgus stability of the elbow ’ of Hackl et al [2]. In a biomechanical analysis of 14 cadaveric specimens before and after shortening osteotomy of the proximal radius by 2.5 mm they determined a significant decrease in radiocapitellar contact pressures up to 250 N of axial loading ( p < 0.041), without compromising valgus stability.…”

“…Whether ulnohumeral degeneration is delayed due to a smaller load shift in proximal radial osteotomy compared to radial head resection does not exclude that a previous healthy ulnohumeral articulation is now prone to developing osteoarthritis. Furthermore, Hackl et al [2] showed that valgus stress will be less after a 2.5‐mm shortening osteotomy compared to radial head resection, likely reducing the chance of tardy ulnar collateral ligament (UCL), subsequent valgus instability and medial elbow pain complaints. However, it remains a fact that valgus strain will increase and may cause tardy UCL elongation and elbow valgisation in the long run.…”

“…Third, Hackl et al [2] showed an advantage of proximal radial osteotomy compared to radial head resection in ulnohumeral loading in cadaveric specimens. Inherently, this set‐up does not allow the results to be translated directly to the clinical setting and requires additional studies.…”