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DOI: 10.1055/a-1894-7149
Ulnaverkürzungsosteotomie – Zwei Wochen Ruhigstellung ausreichend
Ulnar Shortening Osteotomy – Two Weeks of Immobilization SufficientZusammenfassung
Hintergrund Die diaphysäre Ulnaverkürzungsosteotomie (UVO) als operative Behandlung des Ulnaimpaktionssyndromes ist heutzutage standardisiert mit guten bis sehr guten Ergebnissen. Demgegenüber findet sich in der aktuellen Literatur ein breites Spektrum an verschiedenen postoperativen Behandlungsschemata. Die Ergebnisse nach UVO mit modernen, winkelstabilen Implantaten und postoperativer Immobilisierung für 2 Wochen werden vorgestellt.
Patienten und Methoden In einer retrospektiven Datenbankanalyse konnten in einem Zeitraum von 13 Jahren 49 Patienten (31 Frauen, 18 Männer, Durchschnittsalter 37,6 Jahre) mit insgesamt 51 UVO identifiziert und über 73,5 (15,9–146,1) Wochen nachbeobachtet werden. Alle UVO wurden schräg gesägt und mit palmaren, winkelstabilen Implantaten stabilisiert. Postoperativ wurde das Handgelenk für 2 Wochen in 30° Extension in einer dorsalen Unterarmschiene immobilisiert.
Ergebnisse Alle UVO zeigten belastungsstabile Konsolidierungszeichen nach durchschnittlich 7,0 (SD 1,9; 4,9–14,1) Wochen. Die Beweglichkeit der Handgelenke konnte signifikant für die Extension/Flexion von präoperativ 107,6° (60–155) auf postoperativ 123,7° (80–160) und für die Ulnar-/Radialduktion von 55,1° (25–90) auf 60,8° (30–90) verbessert werden (p<0,05). Das Schmerzniveau wurde sowohl in Ruhe von 3,2 (0–8) auf 0,1 (0–2) und unter Belastung von 7,3 (4–10) auf 1,2 (0–9) signifikant reduziert (p<0,01). Insgesamt wurden 5 Komplikationen (9,8%) festgestellt, Pseudarthrosen fanden sich nicht.
Schlussfolgerung Durch die Verwendung von winkelstabilen Implantaten zur Stabilisierung einer UVO kann die Zeitdauer der Ruhigstellung mittels einer dorsalen Unterarmschiene auf 2 Wochen reduziert werden, ohne die Knochenheilung zu kompromittieren.
Abstract
Background Diaphyseal ulnar shortening osteotomy (USO) as surgical treatment of ulnar impaction syndrome is standardized nowadays with good to very good results. In contrast, a wide spectrum of different postoperative treatment regimens can be found in the current literature. The results after USO with modern, angular stable implants with immobilization for 2 weeks are presented.
Patients and Methods A retrospective database analysis identified 49 patients (31 women, 18 men, mean age 37.6 years) with a total of 51 USO over a 13-year period and were followed up for 73.5 (15.9–192.9). All USO were obliquely sawed and stabilized with palmar locking implants. The wrist was immobilized postoperatively in 30° extension in a dorsal forearm splint for 2 weeks.
Results All USO showed load-stable consolidation signs after an average of 7.0 (SD 1.9; 4.9–14.1) weeks. Wrist range of motion was significantly improved in extension/flexion from 107.6° (60–155) preoperatively to 123.7° (80–160) postoperatively and in ulnar/radial deviation from 55.1° (25–90) to 60.8° (30–90) (p<0.05). Pain level was significantly reduced from 3.2 (0–8) to 0.1 (0–2) at rest and from 7.3 (4–10) to 1.2 (0–9) under weight bearing (p<0.01). A total of 5 complications (9.8%) were noted. Nonunion was not found.
Conclusion By using angular stable implants to stabilize a USO, the duration of immobilization can be reduced to 2 weeks without compromising bone healing.
Schlüsselwörter
Ulnaverkürzungsosteotomie - Ulnaimpaktionssyndrom - triangulärer fibrokartilaginärer Komplex - Nachbehandlung - RuhigstellungsdauerKey words
Ulna shortening osteotomy - Ulna impaction syndrome - triangular fibrocartilage complex - postoperative care - immobilization periodPublication History
Received: 15 October 2021
Accepted: 04 July 2022
Article published online:
29 August 2022
© 2022. Thieme. All rights reserved.
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Literatur
- 1 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7: 295-310
- 2 Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg Am 1982; 7: 376-379 DOI: 10.1016/s0363-5023(82)80147-0.
- 3 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; 26-35
- 4 Hulten O. Über Anatomische Variationen der Handgelenkknochen. Acta Radiologica 1928; 9: 155-168 DOI: 10.3109/00016922809176658.
- 5 Stockton DJ, Pelletier ME, Pike JM. Operative treatment of ulnar impaction syndrome: a systematic review. J Hand Surg Eur Vol 2015; 40: 470-476 DOI: 10.1177/1753193414541749.
- 6 Tomaino MM. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg Am 2000; 25: 352-357 DOI: 10.1053/jhsu.2000.jhsu25a0352.
- 7 Milch H. Cuff resection of the ulna for malunited Colles’ fracture. J Bone Joint Surg Am 1941; 23: 311-313
- 8 Cantero J. [Reestablishment of supination by shortening the cubitus in complications of Pouteau-Colles fractures (new technic)]. Z Unfallmed Berufskr 1974; 67: 135-137
- 9 Cantero J. [Shortening of the ulna following fracture of the distal end of the radius (author’s transl)]. Ann Chir 1977; 31: 330-334
- 10 Baek GH, Lee HJ, Gong HS. et al. Long-term outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up. Clin Orthop Surg 2011; 3: 295-301 DOI: 10.4055/cios.2011.3.4.295.
- 11 Rajgopal R, Roth J, King G. et al. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (N Y) 2015; 10: 535-540 DOI: 10.1007/s11552-014-9727-6.
- 12 de Runz A, Pauchard N, Sorin T. et al. Ulna-shortening osteotomy: Outcome and repercussion of the distal radioulnar joint osteoarthritis. Plast Reconstr Surg 2016; 137: 175-184 DOI: 10.1097/PRS.0000000000001870.
- 13 Doherty C, Gan BS, Grewal R. Ulnar shortening osteotomy for ulnar impaction syndrome. J Wrist Surg 2014; 3: 85-90 DOI: 10.1055/s-0034-1372519.
- 14 Owens J, Compton J, Day M. et al. Nonunion rates among ulnar-shortening osteotomy for ulnar impaction syndrome: A systematic review. J Hand Surg Am 2019; 44: 612 e611-612 e612 DOI: 10.1016/j.jhsa.2018.08.018.
- 15 Rayhack JM, Gasser SI, Latta LL. et al. Precision oblique osteotomy for shortening of the ulna. J Hand Surg Am 1993; 18: 908-918 DOI: 10.1016/0363-5023(93)90065-b.
- 16 Sunil TM, Wolff TW, Scheker LR. et al. A comparative study of ulnar-shortening osteotomy by the freehand technique versus the Rayhack technique. J Hand Surg Am 2006; 31: 252-257 DOI: 10.1016/j.jhsa.2005.09.017.
- 17 Terzis A, Neubrech F, Sebald J. et al. Die operative Behandlung des Ulna-Impactions-Syndroms. Oper Orthop Traumatol 2019; 31: 547-556 DOI: 10.1007/s00064-019-0613-9.
- 18 Egol KA, Kubiak EN, Fulkerson E. et al. Biomechanics of locked plates and screws. J Orthop Trauma 2004; 18: 488-493 DOI: 10.1097/00005131-200409000-00003.
- 19 Ahsan ZS, Song Y, Yao J. Outcomes of ulnar shortening osteotomy fixed with a dynamic compression system. J Hand Surg Am 2013; 38: 1520-1523 DOI: 10.1016/j.jhsa.2013.04.040.
- 20 Clark SM, Geissler WB. Results of ulnar shortening osteotomy with a new plate compression system. Hand (N Y) 2012; 7: 281-285 DOI: 10.1007/s11552-012-9417-1.
- 21 Das De S, Johnsen PH, Wolfe SW. Soft tissue complications of dorsal versus volar plating for ulnar shortening osteotomy. J Hand Surg Am 2015; 40: 928-933 DOI: 10.1016/j.jhsa.2014.12.042.
- 22 Finnigan T, Makaram N, Baumann A. et al. Outcomes of ulnar shortening for ulnar impaction syndrome using the 2.7 mm AO ulna shortening osteotomy system. J Hand Surg Asian Pac Vol 2018; 23: 82-89 DOI: 10.1142/S242483551850011X.
- 23 Schmidle G, Kastenberger T, Arora R. Time-Dependent recovery of outcome parameters in ulnar shortening for positive ulnar variance: A prospective case series. Hand (N Y) 2018; 13: 215-222 DOI: 10.1177/1558944717702465.
- 24 Singhal R, Mehta N, Brown P. et al. 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: 441-446 DOI: 10.1142/S2424835520500484.
- 25 Tatebe M, Shinohara T, Okui N. et al. Results of ulnar shortening osteotomy for ulnocarpal abutment after malunited distal radius fracture. Acta Orthop Belg 2012; 78: 714-718
- 26 Jungwirth-Weinberger A, Borbas P, Schweizer A. et al. Influence of plate size and designe upon healing of ulna-shortening osteotomies. J Wrist Surg 2016; 5: 284-289 DOI: 10.1055/s-0036-1582430.
- 27 Smet LD, Vandenberghe L, Degreef I. Ulnar impaction syndrome: Ulnar shortening vs. arthroscopic Wafer procedure. J Wrist Surg 2014; 3: 98-100 DOI: 10.1055/s-0034-1375966.
- 28 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14: 607-612 DOI: 10.1016/0363-5023(89)90175-5.
- 29 Low S, Rau M, Van Schoonhoven J. et al. Standardisierte Operationstechnik der Verkürzungsosteotomie der Elle mit neuer Gleitlochplatte. Handchir Mikrochir Plast Chir 2003; 35: 181-185 DOI: 10.1055/s-2003-41983.
- 30 Zeckey C, Spath A, Kieslich S. et al. Early mobilization versus splinting after surgical management of distal radius fractures. Dtsch Arztebl Int 2020; 117: 445-451 DOI: 10.3238/arztebl.2020.0445.
- 31 Tatebe M, Nishizuka T, Hirata H. et al. Ulnar shortening osteotomy for ulnar-sided wrist pain. J Wrist Surg 2014; 3: 77-84 DOI: 10.1055/s-0034-1372516.
- 32 Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am 1988; 70: 1372-1376
- 33 Beaupre GS, Csongradi JJ. Refracture risk after plate removal in the forearm. J Orthop Trauma 1996; 10: 87-92 DOI: 10.1097/00005131-199602000-00003.
- 34 Pomerance J. Plate removal after ulnar-shortening osteotomy. J Hand Surg Am 2005; 30: 949-953 DOI: 10.1016/j.jhsa.2005.06.005.
- 35 Werner FW, Palmer AK, Fortino MD. et al. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am 1992; 17: 423-428 DOI: 10.1016/0363-5023(92)90342-m.