Ulnar Shortening Osteotomy for Ulnar Abutment Syndrome: The Results of Metaphyseal and Diaphyseal Osteotomies

2020 ◽  
Vol 25 (04) ◽  
pp. 474-480
Author(s):  
Hirofumi Imai ◽  
Masatoshi Takahara ◽  
Mikiro Kondo
Keyword(s):  
Range Of Motion ◽  
Alternative Treatment ◽  
Bone Union ◽  
Cast Immobilization ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Primary Bone ◽  
The Mean ◽  
Temporary Decrease

Background: The purpose of this study was to report the results of metaphyseal and diaphyseal ulnar shortening osteotomies (USO) for the treatment of ulnar abutment syndrome (UAS). Methods: From 2011 to 2016, we performed metaphyseal USO in 8 patients (8 wrists) and diaphyseal USO in 6 patients (7 wrists). The results were investigated in terms of bone union and cast immobilization, wrist and forearm range of motion (ROM). The mean follow-up duration was 29 months. Results: All 14 patients had bone union. The mean duration of bone union in metaphyseal USO and diaphyseal USO were 3.5 months and 4.3 months and the duration of cast immobilization after surgery were 24.2 days and 29.2 days. The mean forearm ROM (degree) were 134.3 (pronation/supination: 66.7/67.6) and 169.3 (pronation/supination: 84.3/85.0) at 3 months after surgery and 173.4 (pronation/supination: 86.0/87.4) and 172.8 (pronation/supination: 87.1/85.7) at 6 months after surgery. Conclusions: The results from this study suggest that metaphyseal osteotomies are an effective alternative to diaphyseal osteotomies for the treatment of ulnar abutment syndrome. Although metaphyseal osteotomies were associated with temporary decrease of pronation, this discrepancy resolved at 6 months postoperatively. Metaphyseal USO has the potential to promote primary bone union and appears to be an alternative treatment for UAS.

scholarly journals Revision Total Elbow Replacement Arthroplasty with an Allograft-Prosthesis Composite: Case Series and Technical Points

2020 ◽  
Vol 25 (2) ◽  
pp. 101-107
Author(s):  
Young Ju Chae ◽  
Hyun Sik Gong
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Bone Union ◽  
Radial Nerve Palsy ◽  
Total Elbow Replacement ◽  
Replacement Arthroplasty ◽  
The Mean ◽  
Elbow Replacement ◽  
Joint Range

Purpose: The purpose of this study was to report the results of revision total elbow replacement arthroplasty (TERA) with an allograft-prosthesis composite (APC). Methods: We retrospectively reviewed 6 patients with an average age of 75 years who had undergone revision TERA with an APC for periprosthetic fracture or loosening of the component. The mean follow-up period was 13 months. We assessed serial radiographs for bone union and evaluated the outcomes in terms of pain visual analogue scale (VAS), the Mayo Elbow Performance Score (MEPS), range of motion, and complications. Results: The APC was used for the humerus in 5 patients and for the ulna in 1 patient. The clinical bone union was achieved at average 9 months after surgery. The mean pain VAS score improved from 6.8 to 1.7, the mean elbow joint range of motion increased from 95° to 129° and the MEPS score improved from 40 to 79 at the last follow-up. There were no major complications such as infection, nonunion, malunion, limitation of motion or refracture. One patient experienced transient radial nerve palsy and another patient a prominent edge of the humeral allobone that needed a trimming surgery later.Conclusion: Revision TERA with an APC provides good functional outcomes and can be recommended as one of the options for failed total elbow arthroplasty.

Limited Wrist Arthrodesis for Scapholunate Advanced Collapse Wrist: Triangle Fixation for Four-Corner Fusion

2016 ◽  
Vol 21 (02) ◽  
pp. 207-211 ◽  
Author(s):  
Kosuke Shintani ◽  
Kenichi Kazuki ◽  
Kiyohito Takamatsu ◽  
Masahiro Yoneda ◽  
Takuya Uemura
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Cast Immobilization ◽  
Wrist Arthrodesis ◽  
The Mean ◽  
Tract Infections ◽  
Slac Wrist

Background: Limited wrist arthrodesis with scaphoid excision is a useful treatment for scapholunate advanced collapse (SLAC) of the wrist. Multiple Kirschner wires were originally used for internal fixation of the four carpal bones, however long-term cast immobilization, pin tract infection, and hardware removal are still problematic. We introduce and evaluate the clinical outcomes of an internal fixation technique; triangle fixation for four-corner fusion, using three headless screws, as an alternative to conventional multiple Kirschner wires for the treatment of SLAC wrist. Methods: Five male patients with SLAC wrist secondary to three scaphoid nonunions and two scapholunate dissociations were treated with four-corner fusion using triangle fixation with three Double-threaded Japan screws. The mean age was 59.5 years (35–79 years) and the mean follow-up period was 40 months. After surgery, short arm splints were applied for 3–4 weeks, and then range of motion exercises were initiated. Results: Wrist range of motion and grip strength both improved postoperatively. At the final follow-up evaluation, bone union was completely achieved and satisfactory pain relief was observed in all patients. Conclusions: Compared with the conventional Kirschner wire technique, the present technique shortens the period of splint immobilization due to a strong compression force in a skewed position, does not require pin removal or cause pin tract infections, and provides satisfactory results.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

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 Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

2019 ◽  
Vol 101 (3) ◽  
pp. 203-207
Author(s):  
S Hassan ◽  
R Shafafy ◽  
A Mohan ◽  
P Magnussen
Keyword(s):  
Distal Radius ◽  
Simple Procedure ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
The Uk

Introduction Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. Materials and methods Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability. Patients were treated with a short oblique ulnar shortening osteotomy, using a Stanley jig and small AO compression plate system. Pre- and postoperative radiographical measurements of inclination, dorsal/volar angulation and ulnar variance were made. Patients were scored pre- and postoperatively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation scores by two orthopaedic surgeons. Mean follow-up was 24 months after surgery. Results Radiographical analysis revealed a change in the ulnar variance with an average reduction of 5.74 mm. Mean preoperative scores were 61.1 (range 25–95.5) for QuickDASH and 70.4 (range 33–92) for Patient-Rated Wrist Evaluation. At the latest follow-up, mean postoperative QuickDASH scores were 10.6 (range 0–43.2) and 17.2 (range 0–44) for Patient-Rated Wrist Evaluation. Differences in scores after surgery for both QuickDASH and Patient-Rated Wrist Evaluation were statistically significant (P < 0.01). Conclusions The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna–carpal impaction.

Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis

2019 ◽  
Vol 40 (8) ◽  
pp. 948-954
Author(s):  
Noriyuki Kanzaki ◽  
Nobuaki Chinzei ◽  
Tetsuya Yamamoto ◽  
Takahiro Yamashita ◽  
Kazuyuki Ibaraki ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
The Mean ◽  
End Stage ◽  
Medial Malleolus Fracture

Background: Total ankle arthroplasty (TAA) has been developed to treat patients with end-stage ankle osteoarthritis (OA). However, there is often difficulty in treating complicated pathologies such as ankle OA with subtalar joint OA and severe talar collapse. Therefore, this study aimed to explore the short-term results and complications of TAA with total talar prosthesis, known as combined TAA, as the new techniques to treat such complicated pathology. Methods: We examined postoperative results including ankle range of motion, Japanese Society for Surgery of the Foot (JSSF) scale, and complications. There were 22 patients (15 women), with mean follow-up of 34.9 (range, 24–53 months), and the mean age was 72 (range, 62–80) years. The main indications for combined TAA included osteoarthritis (18 patients), rheumatoid arthritis (3 patients), and talar osteonecrosis with osteoarthritis (one patient). Results: The mean range of motion improved from 4.0 to 14.4 degrees in dorsiflexion and from 23.8 to 32.0 degrees in plantarflexion. The JSSF scale improved from 50.5 to 91.5 points. Prolonged wound healing occurred in 3 patients, and medial malleolus fracture occurred in 4 patients. Conclusion: Combined TAA was a reliable procedure for the treatment of not only ankle OA following avascular necrosis of talus but also of degeneration of both ankle and subtalar joints. Level of Evidence: Level IV, case series.

scholarly journals Megaprosthesis as a treatment modality for persistent distal femoral nonunion in middle aged adults

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0053
Author(s):  
Shashank Agarwal ◽  
Inder Pawar ◽  
Anil Kumar ◽  
Anjul Verma ◽  
Pawan Kumar
Keyword(s):  
Range Of Motion ◽  
Treatment Option ◽  
Knee Society Score ◽  
Distal Femur ◽  
Fracture Site ◽  
Definitive Treatment ◽  
Full Extension ◽  
Non Union ◽  
The Mean

Introduction: Managing distal femur non-union can be a struggle for any orthopedician as it brings along many perplexities which may not lead to satisfactory patient outcome. The target in these cases should be to reduce the morbidity and allow early rehabilitation of the patient and to accomplish this, megaprostheses can be a feasible option. The orthodox use of megaprostheses is in the musculo-skeletal oncologic surgeries but its use can be extended to traumatic etiologies. These can be offered as a single stage definite procedure in patients who have already undergone several previous surgeries. Here we report a series of four cases of persistent non-union of distal femur treated with megaprostheses and recommend this modality for achieving the desired goal but the indication should be meticulously selected. Hypotheses: Megaprosthesis as a definitive treatment option in persistent distal femur non-union and prevention of repeated surgical intervention. Methods: Four cases of persistent distal femur nonunion with failed osteosynthesis were selected who were initially treated with a distal femur locking plate. Results were assessed in terms of range of motion, limb length discrepancy, knee society score and osteointegration of the components. Results: The mean age of the patients at the time of DFEPR was 49 years (42-55). The mean follow up of patients was for approximately 2 years, with the longest follow up being 3.5 years for the first operated case of the series. The range of motion was from full extension to about 105 degrees of flexion with two patients having an extension lag of 10 degrees. Patients were ambulatory without support. Postoperatively, the mean knee society score was 83 (78–88) at last follow-up as compared to 29 (21-36) in the pre-operative period. No case of infection or loosening was reported. There was 1 cm of shortening in one patient in the operated limb which was compensated by giving shoe raise. Good osseointegration of the megaprosthesis was revealed on both anteroposterior and lateral radiographs. Conclusion: Although there are very limited studies on the use of megaprosthesis for traumatic cases, it can be considered as an alternative when we are left with only arthrodesis or amputation as the final option. Despite the operative challenges, there is marked improvement in pain and functional capacity as experienced by these severely limited patients, which are the hallmarks of a successful salvage. The use of distal femur mega-prosthesis is a novel acumen in cases, where bone stock at the fracture site at distal end of femur is so severely compromised that traditional revision osteosynthesis would not provide stable and durable fixation. The indications for this surgery must be rigorously selected and should only complement osteosynthesis procedures, which remain the reference treatment option.

scholarly journals Early Clinical Results of Arthroscopically Assisted Drilling via the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986893
Author(s):  
Yuji Arai ◽  
Kunio Hara ◽  
Hiroaki Inoue ◽  
Ginjiro Minami ◽  
Yoshikazu Kida ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Osteochondritis Dissecans ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Return To Sport ◽  
Functional Scores ◽  
Arthroscopically Assisted ◽  
The Mean ◽  
Flexion And Extension

Background: We have previously reported the technique of arthroscopically assisted drilling of osteochondritis dissecans (OCD) lesions of the elbow via the radius in a distal-to-proximal direction. With this technique, the entire OCD lesion can be drilled vertically under arthroscopic guidance with pronation and supination of the forearm and flexion and extension of the elbow joint. Purpose: To retrospectively evaluate return to sport, range of motion, and the Japanese Orthopaedic Association–Japan Elbow Society Elbow Function Score (JOA-JES score) after treatment of an elbow OCD lesion by drilling through the radius. Study Design: Case series; Level of evidence, 4. Methods: From November 2003 to January 2006, a total of 7 male adolescent baseball players with OCD lesions of the elbow were treated through use of arthroscopically assisted drilling via the radius. The stage of the OCD lesion was evaluated based on preoperative plain radiographs. Patients were observed for a minimum of 36 months, and clinical analysis included time for return to sport, elbow range of motion, and the JOA-JES score before intervention and at final follow-up. Results: We evaluated all 7 patients at a mean follow-up time of 36.1 months (range, 24-68 months). The stage of the OCD lesion on plain radiography was “translucent” in 1 patient, “sclerotic” in 5 patients, and “loosening” in 1 patient. The mean range of motion before surgery was 131.2° and –4.7° in flexion and extension, respectively, and this improved to 138.6° and 1.1° at final follow-up. The improvement in extension was statistically significant ( P = .04). The mean JOA-JES score of 83.0 before surgery significantly improved to 94.0 at final follow-up ( P < .001). One patient required excision of a free body at 51 months postoperatively, but all patients returned to sports early and without pain at an average of 4.6 months postoperatively. No feature of osteoarthrosis was noted on radiography on the final examination in any patient. Conclusion: The findings of this study demonstrate that arthroscopically assisted drilling of an elbow OCD lesion through the radial head allows for early return to sporting activities as well as improved motion and functional scores.

scholarly journals Functional Outcomes after Corrective Osteotomy of Symptomatic Distal Radius Malunions in Children

2019 ◽  
Vol 09 (02) ◽  
pp. 136-140
Author(s):  
C. A. Selles ◽  
M. A. M. Mulders ◽  
G. R. Roukema ◽  
C. H. van der Vlies ◽  
B. I. Cleffken ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Wrist Joint ◽  
Corrective Osteotomy ◽  
Cast Immobilization ◽  
Level Of Evidence ◽  
Secondary Displacement ◽  
Score Range

Abstract Background Closed reduction and cast immobilization of displaced distal radius fractures carries the risk of secondary displacement, which could result in a symptomatic malunion. In patients with a symptomatic malunion, a corrective osteotomy can be performed to improve pain and functional impairment of the wrist joint. Objective The aim of this study was to assess the functional outcomes of children who underwent a corrective osteotomy due to a symptomatic malunion of the distal radius. Methods Between 2009 and 2016, all consecutive corrective osteotomies of the distal radius of patients younger than 18 years were reviewed. The primary outcome was functional outcome assessed with the ABILHAND-Kids score. Secondary outcomes were QuickDASH (Quick Disabilities of Arm, Shoulder, and Hand) score, range of motion, complications, and radiological outcomes. Results A total of 13 patients with a median age of 13 years (interquartile range [IQR]: 12.5–16) were included. The median time to follow-up was 31 months (IQR: 26–51). The median ABILHAND-Kids score was 42 (range: 37–42), and the median QuickDASH was 0 (range: 0–39). Range of motion did not differ significantly between the injured and the uninjured sides for all parameters. One patient had a nonunion requiring additional operative treatment. The postoperative radiological parameters showed an improvement of radial inclination, radial height, ulnar variance, dorsal tilt, and dorsal tilt. Conclusion Corrective osteotomy for children is an effective method for treating symptomatic malunions of the distal radius. Level of Evidence This is a Level IV study.

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