Nonunion After Using Procedure-Specific Instrumentations for Ulnar Shortening Osteotomy

Document Type : RESEARCH PAPER

Authors

1 Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, USA

2 Rothman Orthopedics Florida at AdventHealth, Orlando, USA

Abstract

Objectives: The primary purpose of this study was to compare the rates of nonunion among different osteotomy designs (company brand) and the rates of nonunion between oblique and transverse osteotomies. We secondarily aimed to assess the differences in reoperation and hardware removal rates after ulnar shortening osteotomy (USO).
Methods: A retrospective cohort study of patients undergoing ulnar shortening osteotomy between 2015 and 2022 in our institute amongst 17 providers resulted in 92 consecutive patients. We included skeletally mature patients who underwent USO for the ulnar impingement abutment diagnosis. Demographic information was collected, including age, gender, race/ethnicity, BMI, and medical comorbidities. Six brand-specific devices were used and compared to the conventional plate fixation. Nonunion was determined based on the final available radiograph with a minimum follow-up of four months.
Results: Of the 92 patients, 83 (90%) had a bone union. There is a remarkable difference in union among implant brands, although statistical analysis was not performed due to the small number of patients in each group. Transverse osteotomy was significantly related to a higher nonunion rate. Out of nine patients with resultant nonunion (10%), three healed after revision surgery (3.2%), two were lost to follow-up (2.2%), and four remained asymptomatic despite radiographic nonunion (4.6%). Plate removal was performed in four patients (4.3%), all of whom were in the union group.
Conclusion: Patients should be informed about the nonunion rate with possible subsequent secondary surgery. Using procedure-specific devices may have mitigated the risk of nonunion.
Level of evidence: III

Keywords

Main Subjects

References

  1. Linscheid, RL. Biomechanics of the distal radioulnar joint. Clinical Orthopaedics and Related Research. Clin Orthop Relat Res.1992 Feb (275):46-55. doi: 10.1097/00003086-199202000-00008.
    2. Moradi A, Binava R, Eslami Hasanabadi S, Vahedi E, Ebrahimzadeh MH. Introduction and Early Outcomes of Intraosseous Distal Radioulnar Joint Prosthesis: A Pilot Study and a Technique on a New Design of the Sauvé-Kapandji Procedure. Arch Bone Jt Surg.2020; 8(6):703-709. doi: 10.22038/abjs.2020.44520.2219.
    3. Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am. 2000; 25(1):55-60. doi:10.1053/jhsu.2000.jhsu025a0055.
    4. Milch H. So-called dislocation of the lower end of the ulna. Ann Surg. 1942; 116(2):282-292. doi: 10.1097/00000658-194208000-00014.
    5. Ebrahimzadeh MH, Moradi A, Vahedi E, Kachooei AR. Mid-term clinical outcome of radial shortening for kienbock disease. J Res Med Sci. 2015; 20(2):146-149.
    6. Rodríguez-Merchán EC, Shojaie B, Kachooei AR. Distal Radioulnar Joint Instability: Diagnosis and Treatment. Arch Bone Jt Surg. 2022; 10(1):3-16. doi:10.22038/ABJS.2021.57194.2833.
    7. Sraj SA, Budoff JE. Ulnar or radial shortening osteotomy with a single saw cut. J Hand Surg Am. 2009; 34(7):1248-1251. doi:10.1016/j.jhsa.2009.04.007.
    8. Nagy L, Jungwirth-Weinberger A, Campbell D, Pino JG. The AO Ulnar Shortening Osteotomy System Indications and Surgical Technique. J Wrist Surg. 2014; 3(2):91-97. doi: 10.1055/s-0034-1375965.
    9. Rayhack JM, Gasser SI, Latta LL, Ouellette EA, Milne EL. Precision oblique osteotomy for shortening of the ulna. J Hand Surg Am. 1993; 18(5):908-918. doi: 10.1016/0363-5023(93)90065-b.                                                                10. Lauder AJ, Luria S, Trumble TE. Oblique ulnar shortening osteotomy with a new plate and compression system. Tech Hand up Extrem Surg. 2007; 11(1):66-73. doi:10.1097/bth.0b013e3180336cc7.
    11. Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. Surgical technique. J Bone Joint Surg Am. 2006; 88 Suppl 1 Pt 2:212-220. doi:10.2106/JBJS.F.00320
    12. Ahsan ZS, Song Y, Yao J. Outcomes of ulnar shortening osteotomy fixed with a dynamic compression system. J Hand Surg Am. 2013; 38(8):1520-1523. doi:10.1016/j.jhsa.2013.04.040.
    13. Braun RM. A comparative study of ulnar shortening osteotomy by the freehand technique versus the Rayhack technique. J Hand Surg Am. 2006; 31(8):1411-1412. doi:10.1016/j.jhsa.2006.07.006.
    14. Clark SM, Geissler WB. Results of ulnar shortening osteotomy with a new plate compression system. Hand (N Y). 2012; 7(3):281-285. doi: 10.1007/s11552-012-9417-1.
    15. Singhal R, Mehta N, Brown P, Cheung G, Brown DJ. A Study Comparing the Outcomes of Transverse Ulnar Shortening Osteotomy Fixed with a DCP to Oblique Osteotomy Fixed with a Procedure Specific Plate. J Hand Surg Asian Pac Vol. 2020; 25(4):441-446. doi: 10.1142/S2424835520500484.
    16. Jungwirth-Weinberger A, Borbas P, Schweizer A, Nagy L. Influence of Plate Size and Design upon Healing of Ulna-Shortening Osteotomies. J Wrist Surg. 2016; 5(4):284-289. doi: 10.1055/s-0036-1582430.
    17. Owens J, Compton J, Day M, Glass N, Lawler E. Nonunion Rates among Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome: A Systematic Review. J Hand Surg Am. 2019; 44(7):612.e1-612.e12. doi:10.1016/j.jhsa.2018.08.018.
The Archives of Bone and Joint Surgery
Volume 11, Issue 11
November 2023
Pages 677-683

Files

History

  • Receive Date: 19 July 2023
  • Revise Date: 05 September 2023
  • Accept Date: 12 September 2023

Share

How to cite

Statistics