Abstract
BackgroundParallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO.MethodsBetween June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated.ResultsThe baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy.ConclusionsThe minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.
Highlights
Since Milch [1] first described distal diaphyseal ulnar shortening osteotomy (USO) in 1941, it has been the most popular surgical procedure for ulnar impaction syndrome (UIS) [2,3,4,5,6,7]
This study aimed to evaluate whether guided osteotomy using a dedicated USO system is beneficial for parallel and reduction osteotomies and healing after USO compared to conventional freehand osteotomy and to identify the surgical factors affecting healing after USO
Complications associated with osteotomy healing, such as metal failure, screw loosening, delayed union, nonunion, and refracture after plate removal, were determined
Summary
Since Milch [1] first described distal diaphyseal ulnar shortening osteotomy (USO) in 1941, it has been the most popular surgical procedure for ulnar impaction syndrome (UIS) [2,3,4,5,6,7]. Despite its good clinical outcomes, its critical shortcomings, including nonunion or delayed union following the procedure, have variable incidence (0–12.7%) and remain unresolved [2, 4, 8]. Healing after USO is affected by multiple factors that are both patients- and surgery-related [9]. The representative and well-known patient-related risk factors for nonunion or delayed union include age, low bone mineral density, obesity, diabetes, thyroid disease, smoking, and alcohol consumption [9,10,11,12,13,14]. It aimed to identify surgical factors affecting healing after diaphyseal USO. The patients” background data, including sex, age, affected side, body mass index (BMI), and bone quality (second metacarpal cortical percentage: 2MCP), were recorded [18]. Complications associated with osteotomy healing, such as metal failure, screw loosening, delayed union, nonunion, and refracture after plate removal, were determined
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