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

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.

Changes in Wrist Joint Contact Area Following Radial Shortening Osteotomy for Kienböck Disease

We hypothesized that the contact area of the articular surface of the wrist joint could be evaluated using a custom-designed analytical program. The aim of the study was to compare the articular contact area of the wrist joint before and after radial shortening osteotomy for Kienböck disease. Nine wrists of 9 patients underwent radial shortening osteotomy for Kienböck disease. Computed tomography (CT) images of the wrist joint were reconstructed using a 3D reconstruction software package. Radioscaphoid and radiolunate joint contact areas and translation of the joint contact area from preoperative to postoperative were calculated using customized software. All patients reported a marked reduction of wrist pain at the 12-month follow-up. The contact area was altered following radial shortening, and the center of the contact area was translated radially and dorsally postoperatively. CT-based analysis revealed that the center of the contact area translated radially following radial shortening.

The Clamshell Osteotomy for Diaphyseal Malunion in Deformity Correction and Fracture Surgery

Diaphyseal malunion poses a great challenge for the orthopedic surgeon, and an inundation of morbidity for the patient. Diaphyseal malunion can cause altered gait, adjacent joint osteoarthritis and body dissatisfaction. This problem is fraught with complications without surgical intervention. There is a myriad of options for the management of a diaphyseal malunion. The clamshell osteotomy was engendered to ameliorate the difficulty in managing this issue. This technique is a viable option to correct diaphyseal malunion about the femur and tibia. Recently, the indications of a clamshell osteotomy have been expanded to function as a derotational or shortening osteotomy.

Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome

Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

An algorithmic approach to total hip arthroplasty in patient with post-polio paralysis and fixed pelvic obliquity

Aims Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening. Methods In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment. Results The mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6o (SD 7.9o) to 1.8o (SD 2.4o; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months. Conclusion Simultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic obliquity. Cite this article: Bone Jt Open 2021;2(9):696–704.