Ulnar Nonunion After Osteoclasis for Rotational Deformities of the Forearm

Dalton, John F.; Manske, Paul R.; Walker, J. Clint; Goldfarb, Charles A.

doi:10.1016/j.jhsa.2006.03.006

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…A variety of rotational osteotomy techniques for treating patients with congenital radioulnar synostosis have been recommended (Dalton et al, 2006;El-Adl, 2007;Ezaki and Oishi, 2012;Horii et al, 2014;Hung, 2008;Lin et al, 1995;Murase et al, 2003;Ogino and Hikino, 1987;Ramachandran et al, 2005;Shingade et al, 2014). Our technique differs from those of previous studies by the use of segmental bone resection and different fixation methods.…”

Section: Discussionmentioning

confidence: 99%

“…As we depend more and more on computerization, having a forearm in supination would seem to be a major functional impairment. Currently, an osteotomy aimed to achieve a neutral to slightly pronated position is widely accepted for managing patients with severe pronation (>60°) (Dalton et al, 2006;El-Adl, 2007;Hung, 2008;Lin et al, 1995;Murase et al, 2003;Ramachandran et al, 2005). However, Eastern Asian people require sufficient forearm supination to use chopsticks.…”

Section: Discussionmentioning

confidence: 99%

“…Several complications have been reported with this technique, however, including loss of correction, nerve palsy and compartment syndrome (Green and Mital, 1979;Hankin et al, 1987;Miura et al, 1984;Ogino and Hikino, 1987;Simmons et al, 1983). To prevent these complications, various surgical interventions have been described with variable results; these include segmental bone resection (Ezaki and Oishi, 2012;Hung, 2008), osteotomy of the radius alone (Horii et al, 2014;Simmons et al, 1983), two-stage osteotomy (Dalton et al, 2006;El-Adl, 2007;Lin et al, 1995) and osteotomy at two sites on both bones (Murase et al, 2003;Ramachandran et al, 2005;Shingade et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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One-stage rotational osteotomy for congenital radioulnar synostosis

Hwang

Kim

Lee

et al. 2015

J Hand Surg Eur Vol

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We report the results of a one-stage rotational osteotomy of the proximal third of the ulna and distal third of the radius with segmental bone resection for treating congenital radioulnar synostosis. We retrospectively reviewed 25 patients (28 forearms) treated by operation. Patients were divided into two groups according to the method of internal fixation at the osteotomy sites. In Group 1 the ulnar osteotomy was stabilized with an intramedullary pin and in Group 2 no fixation was used. The average forearm position improved from 47° pronation before surgery, to 27° supination after surgery. There were no statistically significant differences between the two groups in surgical outcomes. One-stage rotational osteotomy of the proximal third of the ulna and distal third of the radius with segmental bone resection is a simple and safe treatment for patients with congenital radioulnar synostosis. Internal fixation at the osteotomy site seems to be unnecessary. Level of evidence: Level 4.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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One-stage rotational osteotomy for congenital radioulnar synostosis

Hwang

Kim

Lee

et al. 2015

J Hand Surg Eur Vol

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“…They determined that fractures in the proximal third of the ulna were prognostic of increased nonunion. Dalton [37] performed forearm osteoclasis with osteoclasis site in the proximal ulna and stated that 21 ulnas of 69 forearms had either delayed or nonunion. The ulnar union rates decreased significantly when the osteoclasis was performed in the proximal third of the ulna, so we did not carry out osteotomy at this site.…”

Section: Discussionmentioning

confidence: 99%

Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis

Hưng

2008

Journal of Children's Orthopaedics

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Objective To evaluate the clinical and functional results of a technical procedure in the surgical treatment of congenital radioulnar synostosis in children. Materials and methods A prospective study had been undertaken from January 1992 to December 2004. Thirtyfour patients with congenital radioulnar synostosis that are fixed in pronation were recruited. Congenital radioulnar synostosis was classified for two types according to Tachdjian's criteria. All patients were treated by resection of the proximal radius and the distal ulna to remove a segmental bone of both parts of the forearm. After K-wires are inserted intramedullarly into both bones, the forearm is derotated manually, followed by cast immobilization. Results There were 34 patients (52 forearms) with congenital radioulnar synostosis, whom the average age at surgery was 6 years and 3 months. There were two types of congenital radioulnar synostosis: Type 1 in six forearms (11.6%) and Type 2 in 46 forearms (88.4%). The preoperative forearm rotation ranged from 65°to 85°pronation. The postoperative forearm rotation angle was corrected from 0°to 30°; the best end position appears to be 70-100% of pronation. Of the patients, 78.8% had good or excellent results. All patients were operated on without complications; five patients had loss of correction during cast immobilization. Overall, the patient's ability to perform daily activities showed a marked improvement after surgery.Conclusion This method is a simple and safe technique to derotate the forearms of patients with congenital radioulnar synostosis that are fixed in pronation.

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“…Poor healing of osteoclasis and fractures has been reported by few studies due to a relative watershed zone of the blood supply in the proximal ulna. (39)(40). The points of intersection of the imaginary line though crude but provide a reproducible and consistent anatomical reference for osteotomy.…”

Section: Ramachandran Et Al Noted Hypermobility Of the Wrist In All T...mentioning

confidence: 99%

Corrective derotation osteotomies to treat congenital radioulnar synostosis in children: results of a systematic review and meta-analysis

Nema

Ramasubramani

Pasupathy

et al. 2022

JOIO

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BackgroundThe primary objective of this review is to estimate the rotational correction after corrective derotation osteotomies (CDO) for Congenital radioulnar synostosis (CRUS). The secondary objective of this review is to identify the complications with CDO in CRUS, MethodsWe included studies in the English literature from electronic bibliographic databases Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Directory of Open access journals (DOAJ), EMBASE, MEDLINE, ProQuest, PubMed, and Scopus up to December 2020 that determined the effects of CDO in CRUS for two or more cases with a mean follow-up of 1 year or more. We used the National Institutes of health quality assessment tool for case series (interventional) and Modi ed Coleman methodology Score for assessment of Risk of bias in the included studies. ResultsWe pooled 383 forearms (318 participants) from 23 studies with mean age of 6.28±1.75 years. The mean pronation deformity was 72.83±15.64 0 from 22 studies. The CDO derotated forearm to 10.4±5.90 0 of mean pronation in 12 studies and 13.47±9.51 0 of mean supination in 9 studies. One study corrected the forearms to a neutral position. The mean derotation from CDO was 73.13±16.54 0 (35 0 supination to 130 0 pronation). The overall mean difference was -68.26 0 [95% ] of correction favouring supination. There were eight transient nerve palsies and six compartment syndromes from synostosis site osteotomies (4 studies). DiscussionWe had poor-quality studies at a High Risk of bias on the described tools of assessment. We could estimate the directional effect of CDO in CRUS favouring correction from pronation to supination; however, due to the heterogeneity among studies, we cannot comment on the most e cient and least harmful CDO techniques. The single bone osteotomies seem to be e cient, simple, and reportedly low on complications but need evaluation. We cannot de ne the indications for correction and expected improvement in functional outcomes from osteotomy techniques.

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Ulnar Nonunion After Osteoclasis for Rotational Deformities of the Forearm

Cited by 17 publications

References 21 publications

One-stage rotational osteotomy for congenital radioulnar synostosis

One-stage rotational osteotomy for congenital radioulnar synostosis

Derotational osteotomy of the proximal radius and the distal ulna for congenital radioulnar synostosis

Corrective derotation osteotomies to treat congenital radioulnar synostosis in children: results of a systematic review and meta-analysis

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