Outcomes and Complications of Ulnar Shortening Osteotomy: An Institutional Review

Rajgopal, Raghav; Roth, James H.; King, Graham J.W.; Faber, Ken; Grewal, Ruby

doi:10.1007/s11552-014-9727-6

Cited by 27 publications

(29 citation statements)

References 36 publications

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“…16,23,24,27 Conversely, Rajgopal et al reported that more than 20% of patients had delayed union or nonunion and that 45% required hardware removal because of plate irritation. 37 Chan et al also noted a high risk of plate irritation (51%). 38 These high complication rates of USO can support our recommendation that USO can be used only for recalcitrant cases after arthroscopic debridement.…”

Section: Discussionmentioning

confidence: 97%

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear

Saito

Malay

Chung

2017

Plastic &Amp; Reconstructive Surgery

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Background Evidence regarding the effectiveness of arthroscopic debridement for a triangular fibrocartilage complex (TFCC) tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of debridement for TFCC tears. Methods We searched all available literature in the PubMed, EMBASE.com, and MEDLINE (Ovid) databases for articles reporting on TFCC tear debridement. Data collection included arc of motion, grip strength, patient reported outcomes, and complications. Results A total of 1,723 unique studies were identified, of which 18 studies met our criteria. The mean pre- and post-arc of wrist extension/flexion motion were 120° and 146° (6 studies). The mean pre -and post-grip strength were 65% and 91% of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (6 studies) and pain visual analogue scales (VAS, 7 studies) improved from 39 to 18, and from 7 to 3 respectively. The mean pain-VAS after debridement was 1.9 in ulnar positive groups and 2.4 in ulnar neutral and negative groups. Eighty seven percent of patients returned to their original work. Conclusion Patients reported reduced pain, improved functional and patient-reported outcomes after debridement of TFCC tears. Most patients after debridement returned to previous work with few complications. Though some of these cases may require secondary procedures, simple debridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.

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Section: Discussionmentioning

confidence: 97%

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear

Saito

Malay

Chung

2017

Plastic &Amp; Reconstructive Surgery

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“…[1][2][3][4][5][6][7][8][9][10][11] Small changes in ulnar variance create significant changes in force transmission through the ulnocarpal joint. 12 Classically, diaphyseal osteotomy has demonstrated encouraging short-and midterm results [13][14][15][16][17] but several complications have been reported with this technique, including residual ulnar positive variance, 17 hardware prominence requiring removal, [18][19][20][21] delayed union or nonunion, [22][23][24][25] and complex regional pain syndrome. 25,26 More recently, distal metaphyseal ulnar-shortening osteotomy has been reported in several studies with promising results.…”

mentioning

confidence: 99%

“…12 Classically, diaphyseal osteotomy has demonstrated encouraging short-and midterm results [13][14][15][16][17] but several complications have been reported with this technique, including residual ulnar positive variance, 17 hardware prominence requiring removal, [18][19][20][21] delayed union or nonunion, [22][23][24][25] and complex regional pain syndrome. 25,26 More recently, distal metaphyseal ulnar-shortening osteotomy has been reported in several studies with promising results. [27][28][29][30] Metaphyseal cancellous bone has richer blood supply and is less resistant to osteotomy compared with diaphyseal bone.…”

mentioning

confidence: 99%

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

et al. 2019

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Purpose To compare the biomechanical characteristics between diaphyseal and metaphyseal ulnar-shortening osteotomy with respect to (1) maximal shortening achieved at each osteotomy site and (2) force required to achieve shortening at each site. Methods Nine fresh frozen cadaveric upper extremities were affixed through the proximal ulna to a wooden surgical board. A metaphyseal 20-mm bone wedge was resected from the distal ulna and sequential shortening was performed. A load cell was attached to a distal post that was clamped to the surgical board and used to measure the force required for each sequential 5-mm of shortening until maximal shortening was achieved. The resected bone was reinserted, and plate fixation was used to restore normal anatomy. A 20-mm diaphyseal osteotomy was performed, and force measurements were recorded in the same manner with (1) interosseous membrane intact, (2) central band released, and (3) extensive interosseous membrane and muscular attachments released. Results Metaphyseal osteotomy allowed greater maximal shortening than diaphyseal osteotomy with the interosseous membrane intact and with central band release but similar shortening when extensive interosseous membrane and muscle release was performed. Force at maximal shortening was similar between metaphyseal and diaphyseal osteotomy. Sequential soft tissue release at the diaphysis allowed for increased shortening with slightly decreased shortening force with sequential release. Conclusion Metaphyseal ulnar osteotomy allows greater maximal shortening but requires similar force compared with diaphyseal osteotomy. Sequential release of the interosseous membrane permits increased shortening at the diaphysis but requires extensive soft tissue release. Clinical Relevance Both sites of osteotomy can achieve sufficient shortening to decompress the ulnocarpal joint for most cases of ulnar impaction syndrome. The greater shortening from metaphyseal ulnar osteotomy may be reserved for severe cases of shortening, especially after distal radius malunion or in the setting of distal radius growth arrest in the pediatric population. Level of Evidence This is a Level V, basic science study.

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“…In our study, three patients (19%) requested removal of metalwork due to irritation. This is better than most studies that have rates of 30 to 79%, 5,6,12,16,17,22 but not as good as two studies with rates of 0 13 and 7%. 10 However, these studies included a variety of USO plating systems, so new, lower profile USO plates may decrease the irritation and need for metalwork removal.…”

Section: Discussionmentioning

confidence: 52%

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

et al. 2018

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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.

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Outcomes and Complications of Ulnar Shortening Osteotomy: An Institutional Review

Cited by 27 publications

References 36 publications

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

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

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