Radial Osteotomy Research Articles

Use of a free proximal ulnar autograft for ipsilateral radial lengthening in a dog with a short radius and subsequent elbow incongruity

AbstractObjectiveTo report the technique and outcome of proximal ulnar autograft transplantation to achieve ipsilateral radial lengthening in a dog with premature closure of both proximal and distal radial physes.Study designCase report.AnimalsAn 8‐month‐old female spayed Border Collie.MethodsThe dog was presented for a grade III/IV left thoracic limb lameness localized to the elbow. Orthogonal radiographs of both forelimbs revealed a 7% length deficit of the left radius and elbow subluxation indices indicative of left elbow incongruity due to suspect premature closure of both radial physes. Radial lengthening consisted of a proximal ulnar ostectomy, a radial osteotomy, and transplantation of the ulnar autograft into the radial osteotomy site secured with an eight‐hole dynamic compression plate. Orthopedic examinations were conducted at 2 weeks, 4 weeks, and 3 years postoperatively. Radiographic examinations were completed preoperatively, immediately postoperatively, and at 4 weeks and 3 years postoperatively.ResultsLameness improved with a grade II/IV lameness at 4 weeks postoperatively and complete resolution at 3 years postoperatively. Radiographic examination at 4 weeks showed persistent radial lengthening of 1 cm, and a decreased humeroradial index (HRI), humeroulnar index (HUI), and radioulnar index (RUI) compared with preoperative values. At the 3 year examination, the HRI and HUI had increased indicating progression of elbow incongruity. The patient remained clinically unaffected.ConclusionIn dogs with radial shortening and elbow incongruity, use of an ipsilateral proximal ulnar autograft with rigid internal fixation can be an effective treatment for radial lengthening to improve elbow congruity and resolve lameness.

Current Concepts: Corrective Osteotomy for Extra-Articular Deformity Following a Distal Radius Fracture.

Fracture malunion alters wrist and distal radioulnar joint (DRUJ) biomechanics, resulting in incongruence and instability of the DRUJ. Selected patients with painful functional limitation and significant deformity of the radius, but without advanced degenerative joint disease, may benefit from corrective distal radial osteotomy. Non-union and complications arising from metalwork are the most common reasons for reoperation. Surgeons should have a good understanding of risks and complications in order to fully inform their patients and manage expectations. This article reviews the biomechanical effects of radial malunion and the current concepts for treatment. Distal radial osteotomy is suitable for symptomatic patients with angular radial deformity and shortening. Evidence supports a volar approach without bone grafts for modest corrections. Bone grafts or synthetic bone substitutes are appropriate for larger corrections. Functional improvements are reported regardless of technique. Despite a high complication rate, patient satisfaction with the corrective radial osteotomy is high.

Anatomic and Biomechanical Study of the Forearm Interosseous Membrane, Distal Oblique Bundle, and Triangular Fibrocartilage Complex: Role in Galeazzi Fracture Dislocation

The purpose of this study was to measure distal radioulnar joint (DRUJ) dislocation and radioulnar displacement associated with sequential sectioning of the different bands of the interosseous membrane and triangular fibrocartilage complex in the simulation of a Galeazzi fracture dislocation. Twelve fresh-frozen cadaver forearms were dissected. We examined the anatomy and function of the forearm interosseous membrane. Each forearm was then mounted onto a biomechanical wrist and forearm device. In the control group, radial osteotomy was performed and the degree of DRUJ displacement with progressive loads was measured. In addition to radial osteotomy, in group 1, the central band (CB) was sectioned; in group 2, the CB, distal membranous portion of the interosseous membrane, and distal oblique bundle were sectioned; and in group 3, the CB, distal membranous portion of the interosseous membrane, distal oblique bundle, and triangular fibrocartilage complex were sectioned. The radioulnar displacement (mm) at 25 N, 50 N, and 75 N was recorded. In group 1, applying progressive loads resulted in an average DRUJ displacement of 4.3, 5.9, and 7.9 mm, respectively. In group 2, the displacement was 5.2, 5.7, and 6.9 mm, respectively. In group 3, the displacement was 6.2, 8.1, and 9.9 mm, respectively. Our study showed a correlation between increase in the load applied to the same injury and the degree of displacement (P= .001). In group 3, the degree of DRUJ displacement was statistically increased compared to the other groups (P= .04). Migration of the radius under loads implies disruption of both the CB and triangular fibrocartilage complex. The distal oblique bundle by itself does not seem to have a relevant role in radioulnar displacement at the DRUJ. This study provides insights into the interosseous membrane and stability of the DRUJ, which can contribute to a better understanding of Galeazzi fracture-dislocations.

Comparison of three-dimensional printed patient-specific guides versus freehand approach for radial osteotomies in normal dogs: Ex vivo model.

To compare the accuracy of three-dimensional (3D) printed patient-specific guide (PSG) with a freehand (FH) approach for radial osteotomies in ex vivo normal dogs. Experimental study. Twenty four ex vivo thoracic limb pairs from normal beagle dogs. Computed tomography (CT) images were collected preoperatively and postoperatively. Three osteotomies tested (n = 8/group) were: (1) uniplanar 30° frontal plane wedge ostectomy, (2) oblique plane (30° frontal, 15° sagittal) wedge ostectomy, and (3) single oblique plane osteotomy (SOO, 30° frontal, 15° sagittal, and 30° external). Limb pairs were randomized to a 3D PSG or FH approach. The resultant osteotomies were compared with virtual target osteotomies by surface shape-matching postoperative to the preoperative radii. The mean ± standard deviation osteotomy angle deviation for all 3D PSG osteotomies (2.8 ± 2.8°, range 0.11-14.1°) was less than for the FH osteotomies (6.4 ± 6.0°, range 0.03-29.7°). No differences were found for osteotomy location in any group. In total, 84% of 3D PSG osteotomies were within 5° deviance from the target compared to 50% of freehand osteotomies. Three-dimensional PSG improved FH accuracy of osteotomy angle in select planes and the most complex osteotomy orientation in a normal ex vivo radial model. Three-dimensional PSGs provided more consistent accuracy, which was most notable in complex radial osteotomies. Future work is needed to investigate guided osteotomies in dogs with antebrachial bone deformities.

Midcarpal Instability.

Midcarpal instability (MCI) of the wrist represents multiple distinct clinical entities that all have in common abnormal force transmission across the midcarpal joint. This can be asymptomatic but can also result in painful wrist motion, a characteristic catch-up clunk, and symptoms of instability. The carpus is stabilized by numerous extrinsic and intrinsic ligaments. Dynamic joint reactive forces between the proximal and distal carpal rows help create reciprocal motion, which results in smooth, physiologic wrist mechanics. Diagnosis of MCI requires a thorough history, physical examination, and adequate imaging. MCI can be managed nonsurgically with activity modification, physical therapy, specialized orthotics, medications, and corticosteroid injections. A variety of surgical treatment options exists to treat symptomatic MCI. These include arthroscopic thermal capsulorrhaphy, ligament repair or reconstruction, radial osteotomies, and limited radiocarpal or intercarpal fusions. Capsulorrhaphy or ligament repair is favored for mild to moderate cases; osteotomies can be used for the correction of bony deformities contributing to instability, whereas partial wrist arthrodesis is indicated for severe or recurrent instability and fixed deformities.

Novel Descriptions of the Radial Osteotomy in Kienböck’s Disease: A Systematic Review

Kienböck's disease consists of intrinsic and extrinsic characteristics that coalesce into a pathology with multifactorial etiology. Mechanical, morphological, and vascular factors have been identified as contributory. Radial osteotomy is one of the most commonly used surgical treatment for late-stage Kienböck's disease. Despite its frequent use and reported value, the specifics of radial osteotomy have not been described in aggregate. Our objective was to review the recent literature for descriptions of the radial osteotomy techniques used for treatment of Kienböck's disease. The inclusion criteria for the systematic review were as follows: (1) patients aged >18 years, (2) a publication date no older than 2012, and (3) a complete description of the distal radius osteotomy technique, including verbiage that specified numeric dimensions of bony resection or verbiage that detailed a goal in terms of a radiographic parameter that would guide the bony resection. The studies were grouped according to the stated description of radial osteotomy. This process yielded the following three main groups: (1) studies that used radial shortening, (2) studies that used lateral closing wedge osteotomy or combined lateral closing wedge with radial shortening, and (3) novel osteotomy descriptions. The Kienböck's disease literature predominantly describes an osteotomy to shorten the radius by 2-3 mm. In some studies, the degree of radial shortening corresponded to the value necessary to achieve near-neutral ulnar variance. The common goal in using lateral closing wedge osteotomy was to achieve a radial inclination of 5° to 15°. Unique wedge resections, some with multiplanar corrections, have been recently described with each purporting specific advantages. Our findings support the premise of mechanical and biologic efficacy for radial osteotomy, with satisfactory results being reported across a wide spectrum of osteotomy techniques.

Change in capitate shift after osteotomy for distal radial fracture malunion.

Loss of anterior tilt after a distal radial fracture can lead to carpal malalignment, which may cause functional impairment. The aim of this study was to establish whether distal radial osteotomy for malunion, which primarily restores the dorsal tilt, will also improve carpal malalignment as measured by capitate shift. Radiographs of 67 patients who underwent osteotomy after malunion of a distal radial fracture were reviewed. Measurements of capitate shift and dorsal tilt were recorded. Linear regression modelling was used to assess the relationship between dorsal tilt and capitate shift. Change in capitate shift was strongly associated with change in dorsal tilt following osteotomy. This relationship was maintained on long-term radiographs. Capitate shift is strongly related to dorsal tilt following a distal radial fracture. Correcting the dorsal tilt during an osteotomy, therefore, will improve capitate shift and carpal malalignment. Capitate shift is unrelated to age, sex and is easy to visually assess.Level of evidence: IV.

Negative Ulnar Variance Lessens DRUJ Instability After DRUJ Disruption: A Biomechanical Analysis.

The purpose of this study was to perform a biomechanical investigation on the effect of ulnar variance (UV) on the stability of the distal radioulnar joint (DRUJ) prior to and after DRUJ sectioning. Ten cadaveric forearm specimens were included in the study and baseline UV was assessed radiographically. Radial motion relative to the ulna was evaluated using Intel real sense cameras and a custom developed program. The forearms were dissected, and a radial osteotomy was performed. Using a custom-made plate, radial stability was assessed with an UV of + 4, 0, and -4 mm by measuring the maximum and minimum radial position relative to the ulna during a simulated Shuck test. The volar radioulnar ligaments and triangular fibrocartilage complex (TFCC) were then sectioned, and testing was repeated at each UV state. Sectioning significantly increased radial translation at neutral (P = .008), +4 mm UV (P = .008), and -4 mm UV (P = .018). There were no significant differences in translation between the 3 UV groups with the DRUJ intact (P = .124). The ulnar negative (-4 mm) state had significantly lower translation compared to the positive (+4 mm) (P < .001) and the neutral (0 mm) (P = .026) UV states. There were no significant differences between the positive and neutral UV groups with the DRUJ sectioned. Fixating the radius in -4 mm of ulnar negativity significantly decreased radial translation after sectioning the volar radioulnar ligament and TFCC. Ulnar variance had no effect on stability with an intact DRUJ. Biomechanical Study.

CLOSED WEDGE OSTEOTOMY FOR THE CORRECTION OF FOREARM DEFORMITIES IN HEREDITARY MULTIPLE OSTEOCHONDROMA A CASE REPORT.

Introduction-Hereditary multiple osteochondroma is rare form of skeletal dysplasia with autosomal inheritance .during childhood ,these cartilage capped bone tumors grow outward from long bone metaphysis ,leading to metaphyseal remodeling and asymmetric longitudinal bone growth. Forearm deformities affect 30% to 60%of patients with HMO. Patient typically complaining of functional disability cosmetic impairment ,and sometimes pain. The deformities may involve a relative shortening ulna bowing of radius, ulnar deviation of the hand and wrist and permanent subluxation or dislocation of radial head. A 15 years old male patient presented Presentation Of Case- with bowing of right forearm with occasionally pain and he also complaining of pain in right shoulder ,knee joint. on a scanogram of right forearm shows ulnar variance -10,radial articular angle 40 degree, radial bowing .07 ,and radial length (121)cm abnormal carpal slip 6 .The patient was managed with surgical intervention. radial osteotomy and resection of osteochondroma and xation with distal radius locking plate and immobilization with long arm cast. patient recover with correction of deformity. The study ndings conrm our hypothesis that radial Discussion- closed wedge osteotomy combined with osteochondroma resection improves the clinical and radiological outcome in this case Masada type 1 deformity (1) increase in the radial articular angle and ulnar variance (2) a decrease in radial ulnar length discrepancy (3) radial shortening (4) correction of carpal slip and bowing of the radius .The decrease in the radial ulnar length discrepancy produced by radial osteotomy probably prevented radial head dislocation because no episode of radial head dislocation was observed due to radial ulnar length discrepancy. This surgical technique is safe and reliable and no episode of necrosis or infection was observed while this technique probably stops the deformity from getting worse. While several treatment Conclusionoption are possible, it make sense to use a simple ,rapid procedure that is not associated with complication or pain-namely radial corrective osteotomy with osteochondroma resection- in children at the end of growth in whom the severe, progressive, radial deformities are associated with HMO.

The influence of sagittal deformity of the distal radius on pronosupination: a cadaver study.

We performed a cadaver study using seven fresh-frozen adult upper limbs to assess the impact of increasingly larger distal radial deformity in the sagittal plane on the range of motion in pronation/supination. Three palmar (20°, 30° and 40° angulations) and three dorsal (10°, 20° and 30° angulations) tilt deformities, without any radial shortening, were simulated by performing a radial osteotomy and using custom-made three-dimensional-printed anterior plates. We measured the maximum unconstrained pronation and supination before the osteotomy and after each induced deformation. There was a decrease in the median pronation and supination values for all palmar and dorsal tilt deformities. The pronation range was more impaired than the supination range, and dorsal tilt deformities caused the greatest loss in forearm rotation. Our results suggest that forearm rotation in both pronation and supination is reduced as soon as 10° to 20° distal radial deformity occurs in the palmar or dorsal direction.

Medium to long term functional and radiographic outcomes in patients with Madelung's deformity treated by isolated or combined radioulnar osteotomy

IntroductionMadelung's deformity is a rare congenital condition of the wrist that can cause pain, aesthetic concerns, reduced range of motion and grip strength. Currently, there is no consensus on the optimal age for surgery or whether operative procedures can be isolated or combined depending on the extent of the deformity. The main objective of our study was to analyze the postoperative functional clinical results at a minimum of 3-years follow-up in patients operated on for Madelung's deformity. The secondary objectives were (1) comparison of preoperative and postoperative radiographic parameters, and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical procedure. HypothesisThe surgery offered at our center achieves clinical and radiological result necessary for long-term activities of daily living, and varies according to the severity of the distal radial deformity. Patients and methodsWe carried out a retrospective observational monocentric study including patients operated on between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score), and radiographic assessments were performed before and after the last follow-up. ResultsThe study included 11 patients (12 wrists) with a mean age of 17±7.3 years and a mean follow-up of 8.1 years (4–12.3). The mean VAS was 2.3 (0–6) and the mean PRWE score was 37 (0–108). The mean flexion-extension arc was 134° and that of pronation and supination was 142°. The mean grip strength was 25.8±11.8kg. Four out of 6 radiographic criteria were significantly improved. An isolated radial osteotomy or combined radioulnar osteotomy was performed when the sagittal radial tilt was greater than 30° and protrusion of the lunate greater than 5mm, otherwise below these values, an isolated ulnar osteotomy was performed. DiscussionOur center offers surgical management of Madelung's deformity by osteotomy which improves the majority of postoperative radiographic parameters and gives satisfactory clinical and radiographic results after a mean follow-up of 8.1 years. The surgery is influenced by the severity of the distal radial deformity, including protrusion of the lunate and sagittal radial tilt. Level of evidenceIV, Retrospective study.

Risk factors for redislocation of chronic Monteggia fracture-dislocation in children after reconstruction surgery.

Monteggia fracture-dislocation refers to traumatic ulnar fractures and dislocation of the radial head, which is one of the most frequently missed injuries, especially in children. The most widespread attitude towards chronic Monteggia lesion is the open reduction of the radial head associated with ulnar osteotomy with or without annular ligament reconstruction. Our study aimed to analyze the risk factors for redislocation after surgical management of chronic Monteggia lesion and the benefits of annular ligament reconstruction and radiocapitellar pinning in paediatric. We retrospectively reviewed patients treated with reconstruction surgery for chronic Monteggia fracture-dislocation in our department between 2005 and 2017, with a minimum two years' follow-up. The reconstruction surgery included ulnar osteotomy performed in all patients, annular ligament repair or reconstruction or fixation of radiocapitellar joint, or radial osteotomy in some patients. We collected the related clinical data and evaluated the risk factors of redislocation using logistic regression analyses and a two-piecewise linear regression model with a smoothing function, after reconstruction. Throughout a mean six years' follow-up (range, 2-14years), 62 patients (42 males, 20 females; average age 6.49years range, 2-13years) were reviewed. Of the radiocapitellar joints, 16.1% was noted to have redislocation. Univariate risk analysis showed age, time from injury to surgery, and radial osteotomy were risk factors for a recurrent radiocapitellar redislocation. Time from injury to surgery was found to be independent predictor of redislocation in multivariate analysis. However, there were significant nonlinear associations between time from injury to surgery and redislocation in multivariate logistic regression analysis after multivariate adjustment (p for nonlinear = 0.023). Every one month increase was associated with a 1.37-fold increase in redislocation, in participants within oneyear after injury. In conclusion, the surgery of chronic Monteggia fracture-dislocation should be done as quickly as possible within oneyear after injury. Associated annular ligament reconstruction or fixation of radiocapitellar joint does not seem to be helpful.

Failure of VariAx® Distal Radial Locking Plate: Fractographic Analysis and Report of Two Cases

We describe two cases of atraumatic fracture of VariAx® distal radial locking plate following its use in distal radial osteotomies. The plates fractured through an unused screw hole at the level of the osteotomy. Scanning electron microscopy was used to evaluate the fracture surfaces. This confirmed that there had been fatigue failure and did not find evidence of abnormal composition or structure of the metal. These cases are important because they highlight that this new and innovative implant can be prone to failure, and demonstrate the requirement for adequate surgical technique and metalwork protection following surgery.

Simultaneous three-dimensional correction of percutaneous radial osteotomy with circular external fixator in Madelung’s deformity

Partial deficiency of distal radial and volar cartilage plate growth is the main pathology in Madelung’s deformity. Surgical treatment can use a Taylor Spatial Frame (TSF) external fixator, which provides simultaneous multiplanar correction and lengthening after radial osteotomy, sparing Vickers’ ligament and the ulna. We sought to evaluate the radiological and functional results of Madelung’s deformity correction by TSF, by retrospectively analyzing eight Madelung’s deformities in seven patients between August 2011 and May 2015. Mean age was 14.8 years (range, 11–26), and mean follow-up 35.1 months (24–78). We evaluated demographic data and pre- and post-operative radiological and functional results. Mean preoperative visual analog pain scale score improved from 7.7 to 1.6. Mean preoperative DASH score improved from 19.1 (9.5–46.6) to 3.7 (2.3–6.8). Mean preoperative radial length improved from 184 mm (138–209) to 196 mm (142–213). We think that software-based correction using a TSF is a safe solution in Madelung’s deformity, with minimal margin of error and risk of postoperative stiffness and infection. Level of evidenceIV.

Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis.

To review surgical management and outcomes of missed pediatric Monteggia fractures. A systematic review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library from inception through March 2, 2020. The keywords were "Monteggia fracture," "missed Monteggia," "neglected Monteggia," "chronic Monteggia," and "chronic radial head dislocation." All original human studies on missed pediatric Monteggia fractures were included. Congenital Monteggia fractures and isolated radial head dislocations were excluded. The revised Methodological Index for Nonrandomised Studies tool was used to assess the quality of studies. Each patient's data were retrieved individually. The χ2 test and Fisher exact test were used to analyze the difference in outcomes for different surgical managements. Multivariate analysis was performed for variables that were significant on univariate analysis. Thirty studies with 600 patients were included. Proximal ulnar osteotomies (P = 0.016) and the absence of transcapitellar pinning (P = 0.001) were the most significant predictors for eventual reduction of radial head. Other surgical management variables were not significant predictors. These include open or closed reduction approach of radial head reduction; presence or absence of ulnar osteotomy; presence or absence of lengthening, angular correction, overcorrection, or bone grafting of ulnar osteotomy; type of fixation for ulnar osteotomy; presence or absence of radial osteotomy; presence or absence of annular ligament repair or reconstruction; and repair or reconstruction of annular ligament. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Recent Advances in Assessment and Treatment in Kienböck's Disease.

Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.

Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up.

The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.

Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease

The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD). In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n= 54) or radial osteotomy (group B; n= 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up. Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively. An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD. Therapeutic II.

Radial Osteotomy for Kienböck Disease: Clinical and Radiological Comparison between Younger and Older Patients

Background: The usefulness of radial osteotomy for older patients remains unclear. The purpose of this study was to compare the clinical and radiological outcomes of radial osteotomy with volar locking plate between younger and older patients with Kienböck disease stages II to IIIB. Methods: This was a retrospective comparative study of 21 consecutive patients treated at our department. Lichtman's classification was used for staging, and four patients had stage II, six patients had stage IIIA, and 11 patients had stage IIIB disease. We divided them into two groups to compare the radiological and clinical results between younger (younger than 40 years) and older patients. The mean follow-up periods in the younger and older groups were 4 and 3.6 years, respectively. For radiological assessment, we evaluated the carpal height ratio (CHR), Stahl index, and union of the fractured lunate. For clinical assessment, we examined the range of motion of the wrist, grip strength, numeric rating scale (NRS) for pain, and the patient-reported Hand20 score preoperatively and at the final follow-up. Results: There were 12 patients in the younger group with a mean age of 23 years (range, 12-37 years), and 9 in the older group with a mean age of 56 years (range, 40-74 years). There were no intra- and post-operative complications in either group. Radiological improvement, including CHR, Stahl index, and union of the fractured lunate, was more common in the younger group than in the older one, as was the case for clinical improvement. However, even in the older group, significant clinical improvement, including the range of motion of the wrist, NRS for pain, and the Hand20 score, was seen postoperatively. Conclusions: Radial osteotomy appears to be a safe and reliable option in older symptomatic patients with Kienböck disease stages II to IIIB.

Madelung Deformity: Surgical Correction with Radial Dome Osteotomy

Madelung deformity is a rare wrist malformation caused by a growth disturbance of the palmar and ulnar part of the distal radial physis. The aim of this study is to evaluate the outcome of radial dome osteotomy in patients affected by Madelung deformity. The endpoint of this operation is to improve the orientation of the articular surface of the radius, so as to support to the carpal bones. Between 2017 and 2019, in our clinic, 4patients were treated using this technique. Post-operative pain was evaluated using the NRS. Functional outcomes were assessed through evaluation of ROM, grip strength via Jamar dynamometer and using DASH questionnaire. The aesthetic defects were estimated using a section of the Michigan Hand Outcome Questionnaire. Correction of deformities was evaluated on post-operative RX using McCarrol Criteria. Were also analyzed the accuracy and tolerance of the plates used.