scholarly journals A Study Comparing the Outcomes of Transverse Ulnar Shortening Osteotomy Fixed with a DCP to Oblique Osteotomy Fixed with a Procedure Specific Plate

2020 ◽  
Vol 25 (04) ◽  
pp. 441-446
Author(s):  
Rohit Singhal ◽  
Nisarg Mehta ◽  
Phil Brown ◽  
Graham Cheung ◽  
Daniel J. Brown
Keyword(s):  
Removal Rate ◽  
Dynamic Compression ◽  
Implant Removal ◽  
Union Rate ◽  
Non Union ◽  
Oblique Osteotomy ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Radiological Healing ◽  
Removal Of Hardware

Background: Ulnar shortening osteotomy (USO) is a well-established procedure for ulnar impaction syndrome. Various types of osteotomies have been described. Methods: A retrospective cohort study was conducted to compare the results of transverse osteotomy (TO) fixed with a small fragment dynamic compression plate (Synthes, Pennsylvania, USA), to oblique osteotomy (OO) fixed with a procedure specific plate and instrumentation system (Acumed LLC, Oregon, USA). A total of 39 patients underwent TO and 62 patients underwent OO between 2007 and 2016. The main outcomes compared were rate of union, duration of radiological healing, implant removal rate and other complications. Results: The two groups were comparable with regards to demographics, side operated and smoking status (p > 0.05). Amongst the TO group; 36 out of 39 patients (92.3%) achieved union, 3 patients (7.7%) developed non-union. Six out of the 36 healed TO (16.6%) required removal of hardware due to implant-related pain. No other complications were recorded amongst TO group needing surgical intervention. Amongst the OO group, 2 of the early cohort of 62 patients (3.2%) sustained acute failure of the metalwork due to technical error. One of the remaining 60 patients (1.6%) developed non-union giving an overall union rate of 95.2%. Two patients out of 59 healed OO (3.3%) required removal of hardware. Conclusions: Although there were 2 early failures, there was a trend towards improved union rate with OO, but this did not reach statistical significance (p > 0.05). There was a significantly higher hardware removal rate recorded in TO group (p = 0.023). The OO showed shorter duration for radiological healing than TO (p < 0.05). USO performed with an OO and fixed with procedure specific plate has lower implant removal rate, a shorter duration for radiological healing and comparable union rate to TO fixed with DCP, but needs careful attention to detail.

ULNAR-SIDED WRIST PAIN AFTER FOUR-CORNER FUSION IN A PREVIOUSLY-ASYMPTOMATIC ULNAR POSITIVE WRIST: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 49-51 ◽  
Author(s):  
Hyun Sik Gong ◽  
Su Ha Jeon ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Wrist Pain ◽  
Stage Ii ◽  
Treatment Choices ◽  
Non Union ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Post Traumatic ◽  
Snac Wrist

Scaphoid excision and four-corner fusion is one of the treatment choices for patients who have stage II or III SLAC (scapholunate advanced collapse)/SNAC (scaphoid non-union advanced collapse) wrist arthritis. We report a case of ulnar-sided wrist pain which occurred after four-corner fusion for stage II SNAC wrist with a previously-asymptomatic ulnar positive variance, and was successfully treated by ulnar shortening osteotomy. This case highlights a possible coincidental pathology of the ulnocarpal joint in the setting of post-traumatic radiocarpal arthrosis.

scholarly journals The Effect of Early Active Mobilization on Union Rate after Ulnar Shortening Osteotomy

2018 ◽  
Vol 08 (01) ◽  
pp. 072-075
Author(s):  
Rukhtam Saqib ◽  
Jemma Rooker ◽  
Andreas Baumann ◽  
Rouin Amirfeyz ◽  
Julia Blackburn
Keyword(s):  
Case Series ◽  
Union Rate ◽  
Distal Ulna ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Active Mobilization ◽  
Median Change ◽  
Plaster Casts

Background Ulnocarpal impaction occurs when there is excessive loading between the ulnar carpus and the distal ulna. Ulnar shortening osteotomies (USOs) decompress the ulnocarpal joint. Many studies have evaluated USO but none have considered the effect of early active mobilization on union rate. Questions Does early active mobilization affect rate of union following USO? Does early active mobilization affect rate of complications following USO? Patients and Methods We performed a retrospective review of 15 consecutive patients that underwent 16 USOs between 2011 and 2015. There were seven males and eight females. Median age at time of shortening osteotomy was 47 years (range: 11–63 years). The median time of the procedure was 62 minutes (range: 45–105 minutes) and the median change in ulnar variance was 5.5 mm (range: 0–10.5 mm). Six patients were initially immobilized in incomplete plaster casts postoperatively, while the remainder had only wool and crepe dressings. Early active mobilization commenced after the first postoperative visit at 12 days. Results There was a 100% union rate in our series and 12 patients were pain-free at final follow-up. However, three of the patients with the longest times to union were smokers. Additionally, some patients may have achieved union between follow-up clinic visits. Conclusion Early active mobilization after USO does not affect union rate. Prospective, randomized studies are required to investigate the effect of early active mobilization in light of factors known to increase time to union, such as smoking. Level of Evidence This is a Level IV, case series.

scholarly journals How to Achieve Faster Osteotomy Healing and Prevent Refracture after Ulnar Shortening Osteotomy?

2020 ◽  
Author(s):  
Jong woo Kang ◽  
Soo Min Cha ◽  
Sang-gyun Kim ◽  
In Cheul Choi ◽  
Dong Hun Suh ◽  
...  
Keyword(s):  
Dynamic Compression ◽  
Factors Affecting ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Osteotomy Technique ◽  
Baseline Characteristics ◽  
Group 2 ◽  
Ulnar Impaction Syndrome ◽  
Group 1

Abstract 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 and 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 were not different between the two groups. The osteotomy reduction gap, 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 a guided osteotomy was beneficial to reducing the osteotomy reduction gap during USO.

Ulnar Shortening Osteotomy for Ulnar Carpal Instability and Ulnar Carpal Impaction

1997 ◽  
Vol 22 (4) ◽  
pp. 451-456 ◽  
Author(s):  
M. KÖPPEL ◽  
I. C. HARGREAVES ◽  
T. J. HERBERT
Keyword(s):  
Distal Radioulnar Joint ◽  
Assessment System ◽  
Carpal Instability ◽  
Secondary Osteoarthritis ◽  
Non Union ◽  
Number Of Patients ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Wrist Function ◽  
Ulnar Impaction Syndrome

We report the results of a retrospective review of 47 ulnar shortening osteotomies carried out for ulnar carpal impaction and/or ulnar carpal instability. The average follow-up was 18 months. Wrist function was graded preoperatively and postoperatively using an assessment system modified from Chun and Palmer (1993) . The results show that distal ulnar shortening osteotomy successfully reduces pain and improves wrist function both for ulnar carpal instability (UCI) and ulnar impaction syndrome (UIS) and is equally effective for those patients with combined UIS and UCI. Grip strength and wrist stability were significantly improved and range of wrist and forearm motion was little affected by the procedure. Oblique osteotomies were found to heal faster and to have a lower non-union rate than transverse osteotomies. Although radiographs did show adaptive changes of the distal radioulnar joint in a significant number of patients, there is no evidence (as yet) to suggest that this leads to the development of secondary osteoarthritis.

Comparative Study of Dorsal and Volar Plating for Ulnar Shortening Osteotomy

2020 ◽  
Vol 25 (01) ◽  
pp. 54-58 ◽  
Author(s):  
Yasuhiro Ozasa ◽  
Kousuke Iba ◽  
Nobuyuki Takahashi ◽  
Takuro Wada ◽  
Toshihiko Yamashita
Keyword(s):  
Clinical Results ◽  
Dorsal Side ◽  
Implant Removal ◽  
Unaffected Side ◽  
Group V ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Significant Difference ◽  
Transverse Osteotomy ◽  
Group D

Background: Postoperative results of ulnar shortening osteotomy for ulnar abutment syndrome were compared between groups of patients in whom the plate was placed on the volar side and those in whom the plate was placed on the dorsal side. Methods: A total of 35 wrists of 14 males and 21 females were evaluated. The average age of patients at surgery was 44.3 years, and the average follow-up period was 66.2 months. After transverse osteotomy was performed, the ulna was fixed using a 6-hole LC-LCP or a LC-DCP on the dorsal (group D) or the volar (group V) side, respectively. Imaging and clinical results, rates and reasons for implant removal were evaluated. Results: There were 27 patients in group D and 8 in group V. A significant difference was observed only in the postoperative grip strength compared with that of the unaffected side between groups V and D (102% and 87%, respectively). Implant removal was performed in 18 (64%) patients in group D and in 7 (88%) in group V, and the main reasons for this were pain in group V and discomfort in group D. Re-fracture occurred after implant removal in one patient in group D. Conclusions: There were no differences in the imaging and clinical results depending on the plate position. It is preferable to avoid implant removal by placing the lower profile plate on the dorsal side.

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jong Woo Kang ◽  
Soo Min Cha ◽  
Sang-gyun Kim ◽  
In Cheul Choi ◽  
Dong Hun Suh ◽  
...  
Keyword(s):  
Dynamic Compression ◽  
Factors Affecting ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Osteotomy Technique ◽  
Baseline Characteristics ◽  
Group 2 ◽  
Ulnar Impaction Syndrome ◽  
Group 1

Abstract 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.

scholarly journals Impact of Hardware Choice on Talonavicular Arthrodesis Non-Union Rate

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Daniel Corr ◽  
Parth Kothari ◽  
David I. Pedowitz
Keyword(s):  
Risk Factors ◽  
Talonavicular Joint ◽  
Union Rate ◽  
Fixation Technique ◽  
Triple Arthrodesis ◽  
Non Union ◽  
Patient Demographics ◽  
Single Screw ◽  
Hardware Complications ◽  
Removal Of Hardware

Category: Midfoot/Forefoot; Ankle Arthritis; Hindfoot Introduction/Purpose: Talonavicular arthrodesis is a commonly performed procedure in orthopedic foot and ankle surgery, for conditions including osteoarthritis, instability, and others. The surgery is frequently performed as part of a double or triple arthrodesis. Multiple surgical constructs have been described, including screws, plate/screw constructs, and staple/screw constructs. Few studies exist that specifically focus on the talonavicular joint, and those that do are often limited by low patient volumes. Studies that do study non-union of the talonavicular joint do not offer comparative data on non-union rates between the different methods of fixation. The purpose of this study was to determine the rate of arthrodesis in talonavicular fusion surgery among different fixation techniques and determine if hardware has a significant effect on union rate. Methods: This study is a retrospective single institution, multi-surgeon study evaluating arthrodesis rates in the talonavicular joint. Adult patients undergoing primary talonavicular fusion (isolated or as part of double/triple arthrodesis) from 2015-2018 with a minimum of 3 month radiographic follow-up were studied. Patients undergoing revision talonavicular fusion or fusion as part of Charcot reconstruction were excluded. Patient radiographic and chart notes were reviewed to assess fixation type (single screw, 2-hole compression plate, screw + staple, or 4-hole plate), the status of the arthrodesis at >=3 months and any hardware complications or reoperations following the index procedure. Descriptive statistics were generated for standard patient demographics and co-morbidities. Non-union rates were calculated for the cohort as a whole and for each fixation technique utilized along with the frequency of hardware complications/removal. Univariate analysis was performed to determine risk factors for increased non-union rate, including patient demographics, co-morbidities, and fixation technique. Results: A total of 101 patients were included. Hardware included 69 single screws, 27 two-hole compression plates, and 4 screw + staple constructs. Four patients (3.96%) went on to develop a nonunion of the talonavicular joint, while 10 patients (9.9%) required a removal of hardware procedure following the initial arthrodesis. Of nonunion cases, 3 patients had single screw hardware while 1 had a two-hole plate. Removal of hardware was necessary in 5/69 patients with single screws (7.2%) and 4/27 patients with 2-hole plates (14.8%). Statistical significance could not be concluded when comparing union vs. nonunion patients due to the success of union across hardware groups that resulted in a scarce nonunion patient population (4 patients). Conclusion: This study demonstrates that there are multiple types of hardware appropriate for achieving and maintaining talonavicular fusion. One limitation of this report is that the majority of non-single screw cases utilized a 2-hole plate, with significantly fewer patients utilizing screw + staple and 4-hole plate constructs. Single screw and 2-hole plate hardware techniques achieve excellent rate of union, and physicians can make decisions of which to utilize based on patient factors. Further study is indcated on even larger patient cohorts with increased population of nonunion cases so that significant patient risk factors for nonunion of the joint can be identified. [Table: see text]

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