Ulnar shortening with the ulna osteotomy locking plate

Objective

Ulnar shortening for ulnocarpal unloading using a new device enabling parallel osteotomy, rotation-secured compressive shortening, lag screw placement and hybrid stabilization combined in a solely locking plate construct.

Indications

Idiopathic ulnar impaction syndrome. Posttraumatic radial shortening without major tilting of the radius in the sagittal or frontal plane, rotation deformity and/or translation of the distal fragment.

Contraindications

Advanced arthritis of the distal radioulnar joint (DRUJ), DRUJ type?III according to Tolat, malunion of the distal radius with major tilting of the radius in the sagittal or frontal plane, rotation deformity and/or translation of the distal fragment.

Surgical technique

Mounting of the UOL plate system on the palmar surface of the ulna using standard ulnopalmar exposure. Two parallel 45° osteotomies are performed using an osteotomy guide followed by rotation secured shortening and compression. Stabilization is gained by inserting an interfragmentary lag screw perpendicular to the osteotomy site and applying locking and compression screws.

Postoperative management

Lower arm cast for 4?weeks until radiological signs of bone healing become apparent. To limit negative influence of rotational forces during bone healing, patients were instructed to limit forearm rotation up to 30° in pro-/supination.

Results

Sixteen ulnar shortening osteotomies were performed in 15?patients (6?men, 9?women, average age 49?years) and evaluated retrospectively. In 10?cases a trauma-related pathology was the indication for the procedure. The average follow-up time was 53?weeks (range 12?C93?weeks). Bone union was observed at a median of 10?weeks (range 6?C33?weeks). Overall good clinical results could be achieved with an average shortening of 3.7?mm (range 2.1?C16?mm). In this series, there was one nonunion.     

Femoral shortening by a step-cut osteotomy for leg-length discrepancy in adults

The problem of leg-length discrepancy in the adult differs from that in children. The technique of shortening the femur by the step-cut osteotomy and Küntscher rod fixation to correct leg-length discrepancy in the adult was employed in 14 consecutive patients. There were seven male and seven female patients, ranging in age from 15 to 36 years (average, 22.7 years). The leg-length discrepancy ranged from 2.7 to 11.0 cm (average, 5.6 cm), and the shortening of the longer leg (and thus of the patient) ranged from 2.7 to 7.5 cm (average, 5.0 cm). There were no intraoperative or postoperative complications. All fractures were united clinically and radiologically three to four months after surgery (average, 3.6 months). The follow-up period ranged from two to 18 years (average, 8.9 years). The final leg-length discrepancy was 0 in six patients and ranged from 0.5 to 3.5 cm (average, 1.3 cm) under correction in seven. One patient was overcorrected by 0.5 cm. All patients were satisfied both cosmetically and functionally with the operation.     

Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy

Background

To evaluate the long-term clinical and radiological outcomes of cementless total hip arthroplasty (THA) in high riding hip dislocated patients with previous proximal femoral osteotomy.

Results of step-cut medial malleolar osteotomy

BACKGROUND: Treatment of certain complex ankle pathology, such as a talar body fracture or osteochondral lesion requiring grafting, can necessitate medial malleolar osteotomy for adequate operative exposure. This paper evaluates the step-cut medial malleolar osteotomy for exposure of the ankle joint. METHOD: Fourteen patients with intra-articular pathology, including talar body fractures or osteochondral lesions necessitating extensive intra-articular exposure had step-cut malleolar osteotomy. The average age of the patients was 37 (range 20-90) years, and the average followup was 8 months. RESULTS: All 14 patients had an uncomplicated intraoperative course, with excellent exposure of the ankle joint. All patients had prompt healing of the osteotomy by 6 weeks after surgery without loss of reduction. None of the patients had pain at the osteotomy site. CONCLUSIONS: Step-cut medial malleolar osteotomy is an excellent, reproducible method for extensive exposure of the talar dome.     

Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion

Metacarpal and phalangeal malunion after fracture or replantation frequently causes rotational deformities with scissoring during digital flexion. Transverse osteotomy at the metacarpal base has been advocated for derotation, but this only partially corrects scissoring resulting from phalangeal malunion. We describe the results of rotational step-cut osteotomies at the site of malunion. There were twenty-three osteotomies in eighteen patients; seven metacarpal and sixteen in the proximal phalanx. The value of the technique is supported by the results; speedy healing of bone, satisfactory alleviation of deformity, and a useful gain in range of motion in many patients.     

Ulna oblique osteotomy for radius and ulna length inequality: technique and applications

An ulna that is too long or too short may be responsible for symptoms around the wrist. Several techniques are available to shorten or lengthen the ulna. We have used, among other techniques, an oblique osteotomy which allows the length of the ulna to be modified by sliding the 2 fragments over each other, taking care to keep good contact between them. The main advantage of this technique is that it combines length modification with a reorientation of the distal ulna, to restore congruency of the distal radioulnar joint. When shortening a long ulna, this may help to regain a normal range of pronation and supination. When used to lengthen a short ulna, it stabilizes the distal ulna stump, which may be a cause of pain if unstable and can impinge on the radius. This lengthening is combined with soft tissue procedures to further stabilize the distal stump.Our experience in using it for shortening was mainly in Madelung deformity and, for lengthening, the sequelae of too large a distal ulna resection.     

Fractures of the shaft of the ulna

BACKGROUND: The optimal management for ulnar shaft fractures remains debatable. Investigators have advocated nonoperative management as well as internal fixation of these fractures. OBJECTIVE: The primary objective of this study was to determine the effect of alternative management strategies of fractures of the ulnar shaft on rates of union, infection, and functional outcomes. A secondary objective was to examine outcomes after alternative strategies in managing patients with bone defects.     

The bernese intertrochanteric osteotomy for femoral shortening

Objectives  

Correction of leg length discrepancy through an intertrochanteric shortening osteotomy.     

Percutaneous femoral shortening over a nail using on-site smashing osteotomy technique

European Journal of Orthopaedic Surgery & Traumatology - Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding...