Acta Ortopédica Mexicana

Farías-Cisneros E, Kaufman CL, Scheker LR
Ulnar shortening: results for treatment of distal radioulnar joint pathology and conversion to DRUJ replacement arthroplasty
Acta Ortop Mex 2018; 32 (5)

Language: Inglés
References: 33
Page: 245-250
PDF: 156.19 Kb.

[Fulltext - PDF]

ABSTRACT

Background: Ulnar shortening (US) is used for treatment of ulnar abutment, early osteoarthrosis (OA) and distal radioulnar joint (DRUJ) instability. However, it has never been strongly advocated as a mid-stage procedure to slow OA progression and reduce requirement of secondary DRUJ procedures. The study aim was to determine if a specific sigmoid notch type is likely to lead to DRUJ replacement after US. Methods: A retrospective study of 119 patients (124 wrists) with DRUJ painful early osteoarthritis, ulnar abutment and DRUJ instability that underwent US was performed. The goals of osteotomy were to decrease pain and slow the initiation or progression of OA. Sigmoid notch type, previous trauma, bone healing time, pain relief, ulnar variance and conversion to DRUJ arthroplasty were analyzed. Results: Of the 124 wrists studied, bone healing took 3.33 months of average (union rate 98.3%). Sigmoid notch type distribution was 55.6% for type 1, 25.8% for type 2, and 18.5% for type 3. Of the patients with pain after US, 37 had hardware removal and 13 required a DRUJ semi-constrained arthroplasty. Even though analysis did not show any statistically significant correlation, a slight trend towards association of sigmoid notch type 3 with conversion to DRUJ arthroplasty was found. Conclusion: US has a role in treatment of DRUJ pathology, and its use may delay the need for DRUJ secondary procedures, protecting the native joint. A specific sigmoid notch type does not present risk for OA and does not appear to be related to conversion to DRUJ arthroplasty. Type of study: Therapeutic


Key words: Ulnar shortening, DRUJ arthroplasty, DRUJ sigmoid notch, DRUJ osteoarthritis, DRUJ instability.


REFERENCES

  1. Huang JI, Hanel DP. Anatomy and biomechanics of the distal radioulnar joint. Hand Clin. 2012; 28(2): 157-63.

  2. Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg Br. 1996; 21(5): 587-94.

  3. Wijffels M, Brink P, Schipper I. Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J. 2012; 6: 204-10.

  4. Berger R. Anatomy and basic biomechanics of the wrist. In: American Society for Surgery of the Hand, ed. Hand Surgery Update. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1996: 47-62.

  5. Scheker LR, Ozer K. Ligamentous stabilization of the distal radioulnar joint. Tech Hand Up Extrem Surg. 2004; 8(4): 239-46.

  6. Rajgopal R, Roth J, King G, Faber K, Grewal R. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (N Y). 2015; 10(3): 535-40.

  7. Papatheodorou LK, Baratz ME, Bougioukli S, Ruby T, Weiser RW, Sotereanos DG. Long-term outcome of step-cut ulnar shortening osteotomy for ulnar impaction syndrome. J Bone Joint Surg Am. 2016; 98(21): 1814-20.

  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): 91-7.

  9. Scheker LR, Severo A. Ulnar shortening for the treatment of early post-traumatic osteoarthritis at the distal radioulnar joint. J Hand Surg Br. 2001; 26(1): 41-4.

  10. Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg Am. 2005; 30(4): 719-26.

  11. De Smet L, Fabry G. Orientation of the sigmoid notch of the distal radius: determination of different types of the distal radioulnar joint. Acta Orthop Belg. 1993; 59(3): 269-72.

  12. Sagerman SD, Zogby RG, Palmer AK, Werner FW, Fortino MD. Relative articular inclination of the distal radioulnar joint: a radiographic study. J Hand Surg Am. 1995; 20(4): 597-601.

  13. Hollevoet N, Verdonk R, Van Maele G. The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. J Hand Surg Br. 2006; 31(2): 221-5.

  14. Tham SK, Bain GI. Sigmoid notch osseous reconstruction. Tech Hand Up Extrem Surg. 2007; 11(1): 93-7.

  15. Dickson LM, Tham SK. Osteotomy for sigmoid notch obliquity and ulnar positive variance. J Wrist Surg. 2014; 3(1): 50-4.

  16. Slade JF 3rd, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg. 2007; 11(1): 74-82.

  17. Beckers J, The B, Degreef I, De Smet L. Evaluation of the metaphyseal ulnar shortening technique according to Sennwald. Acta Orthop Belg. 2016; 82(2): 280-6.

  18. Zimmerman RM, Kim JM, Jupiter JB. Arthritis of the distal radioulnar joint: from Darrach to total joint arthroplasty. J Am Acad Orthop Surg. 2012; 20(10): 623-32.

  19. Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am. 2008; 33(9): 1639-44.

  20. Zimmerman RM, Jupiter JB. Outcomes of a self-constrained distal radioulnar joint arthroplasty: a case series of six patients. Hand (N Y). 2011; 6(4): 460-5.

  21. Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev. 2017; 1(5): 191-6.

  22. Rayhack JM. Technique of ulnar shortening. Tech Hand Up Extrem Surg. 2007; 11(1): 57-65.

  23. Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg Am. 1982; 7(4): 376-9.

  24. Megerle K, Hellmich S, Germann G, Sauerbier M. Hardware location and clinical outcome in ulna shortening osteotomy. Plast Reconstr Surg Glob Open. 2015; 3(10): e549.

  25. Sunil TM, Wolff TW, Scheker LR, McCabe SJ, Gupta A. A comparative study of ulnar-shortening osteotomy by the freehand technique versus the Rayhack technique. J Hand Surg Am. 2006; 31(2): 252-7.

  26. Chan SK, Singh T, Pinder R, Tan S, Craigen MA. Ulnar shortening osteotomy: are complications under reported? J Hand Microsurg. 2015; 7(2): 276-82.

  27. de Runz A, Pauchard N, Sorin T, Dap F, Dautel G. Ulna-shortening osteotomy: outcome and repercussion of the distal radioulnar joint osteoarthritis. Plast Reconstr Surg. 2016; 137(1): 175-84.

  28. 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): 908-18.

  29. Wolfe SW, Mih AD, Hotchkiss RN, Culp RW, Keifhaber TR, Nagle DJ. Wide excision of the distal ulna: a multicenter case study. J Hand Surg Am. 1998; 23(2): 222-8.

  30. Savvidou C, Murphy E, Mailhot E, Jacob S, Scheker LR. Semiconstrained distal radioulnar joint prosthesis. J Wrist Surg. 2013; 2(1): 41-8.

  31. Bizimungu RS, Dodds SD. Objective outcomes following semi-constrained total distal radioulnar joint arthroplasty. J Wrist Surg. 2013; 2(4): 319-23.

  32. Lim JW, Lee YB, Lee JS. Late radio-lunate arthritis following ulnar shortening osteotomy. J Orthop Sci. 2017; 22(6): 1142-5.

  33. Becker C, Gilbert A. The ulnar flap –description and applications. Eur J Plast Surg. 1988; 11(2): 79-82.