Ulnar Osteotomy Research Articles

Successful Treatment of Failed Ulnar Osteotomy by Concurrent Radial Osteotomy in a Forearm Malunion

We present a patient with malunion of the ulna and radius, who experienced 2 consecutive healing failures after osteotomy of the ulnar malunion only. The purpose of the surgery was for cosmetic reasons. Healing was finally obtained when a seemingly minimal malunion of the radius was corrected as well. This case suggests concurrent correction of both bone forearm malunion may be required to ensure satisfactory healing

Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease

To assess movement of ulnar segments radiographically, following proximal and midshaft ulnar osteotomy or ostectomy after arthroscopic treatment for dogs diagnosed with medial coronoid disease. Fragmentation and cartilage wear were treated arthroscopically and the presence of incongruity confirmed. Osteotomies were performed at the mid-point or proximal third of the length of the ulna. The distance of separation between the ulnar segments and the adjacent radius were measured and followed by serial radiographs postoperatively until healing had occurred. Proximal oblique osteotomies located at one-third the length of the ulna were associated with the most movement of the ulnar segments, most notably of the proximal segment. Osteotomies or ostectomies performed in the middle demonstrated less segmental movement and on average, slightly longer time to heal. Movement of the ulnar segments in both groups occurred immediately, and then peaked at two to four weeks postoperatively, tending to plateau thereafter. Radioulnar incongruity is considered a facet of the aetiopathogenesis of canine medial coronoid disease. This creates abnormal loads and focal wear along the medial coronoid process. Performing an oblique osteotomy at a location measured at the proximal third of the length of the ulna allows increased movement of the proximal segment, which may result in unloading of the medial compartment. Performing an osteotomy or ostectomy distally dampens segmental movement due to constraint of the interosseous ligament. These findings suggest that a proximal oblique osteotomy at this location creates immediate favourable movement with low morbidity.

Effects of dietary supplementation on bonehealing in bisphosphonate treated rabbits

Objective: The aim of this study was to evaluate the effect of the daily oral administration of vitamin D, calcium, fluoride and vitamin C as dietary supplementation on bone healing in bisphosphonate treated experimental animals (rabbits).Material and methods: Eight young male rabbits divided into two groups after induction of open ulnar osteotomy, both groups received weekly 1 mg/ kg BW of alendronic acid (alendron) orally starting 6 days before osteotomy for five weeks, the experimental group received daily dose of vitamin D, calcium, fluoride and vitamin C as dietary supplementation from the second post operative day for four weeks. The control group received ordinary diet. At the end of the fifth week the animals' sacrificed and the specimens taken for radiological and computerized tomography (CT) scan densimetry and histomorphometric evaluation carried out for the callus at site of osteotomy. Results: All ulnar bone osteotomies in both groups united at the end of the fifth week macroscopically and radiologically. The callus density was measured in site of osteotomy by CT scan densimetry, its mean in the experimental group was 681 ± 219 and in the control group was 492 ± 233. The difference between the experimental and control group was significant, (P value

Neglected pediatric Monteggia fracture dislocation with persistent posterior interosseous nerve palsy: a case report

This is a rare case report of persistent PIN palsy following a case of neglected Monteggia fracture dislocation in a 7-year-old boy. The patient had presented with prominence around the elbow and inability to abduct the thumb, extend the thumb at interphalangeal joint, and inability to extend the fingers at the metacarpophalangeal joints. The index procedure of ulnar osteotomy and closed reduction of radial head did not yield satisfactory results; subsequently, patient underwent a second surgery for open reduction of radial and exploration of the PIN with simultaneous sural nerve grafting. To the best of our knowledge, this is the first case from India describing the use of sural nerve as a cable graft for neglected Monteggia fracture dislocation with nerve palsy.

Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports

IntroductionA Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post-operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation. The literature reports satisfactory results with methods that involve ulnar osteotomy and open reduction of the radial head without annular ligament reconstruction. We used the Ilizarov method in two cases with neglected Monteggia fracture dislocations to stably reduce the radial head without open reduction and annular ligament reconstruction.Case presentationWe report two cases of neglected Monteggia fracture dislocation, in two Kashmiri boys aged four and six years. Using ulnar osteotomy with distraction osteogenesis, we were able to relocate the radial head gradually and maintain the reduction without a requirement for open reduction and annular ligament reconstruction.ConclusionDistraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction.

Ulnar osteotomy for treatment of cubital subluxation, following locking compression plate osteosynthesis of a radius fracture in a foal

SummaryA closed mid‐diaphyseal fracture in a one‐day‐old foal was treated using a 3.5 mm locking compression plate on the cranial aspect of the radius. The foal showed good fracture healing, but a radio‐ulnar synostosis developed despite the absence of transfixation by any implant into the ulna. Four months after surgery the radiographs revealed a cubital subluxation, which was managed by an osteotomy of the ulna at the time of plate removal, allowing the ulna to adjust into a normal position. One year after surgery the foal was clinically sound; the radiographs showed good healing of the osteotomy gap as well as good remodelling of the radius; however, a slight elbow subluxation was present.

Open Osteotomy of ulna as a Model For Fracture Healing Studies in Rabbits.

Background: Bone healing of fractures is still an open field for research due to its biological complexity. Adequately adapted experimental model is essential for understanding the factorsinfluencing the biological process of bone healing. Rabbits provide a good animal model for bone healing studies; its bone had Haversian system similar to human.Material and Methods: Six young locally breaded New Zeeland male rabbits were used in this study, the study conducted in animal house in college of medicine at November and December 2009. Surgical fracture (osteotomy) induced operatively in right ulna under general anesthesia by a hand saw. At the end of fifth weeks, the animals' scarified and the specimens taken for radiological, computerized tomography (CT) scan densimetry and histological examination carried out for bone healing in site of osteotomyResults: All bone osteotomy united at end of fifth weeks macroscopically and radiologically. There was no significant difference in serum calcium, serum phosphate, and serum alkalinephosphatase preoperatively and at end of fifth weeks. The callus density was measured in site of osteotomy by CT scan densimetry and its mean was 302 ± 142. The histological examination of the bone at site of osteotomy show healing with woven bone predominantly with some lamellar bone and cartilage.Conclusion: The present study demonstrated that the ulnar osteotomy without use of external splintage or internal fixation model is a new, easy to perform and can be used as a model forfractures healing studies.

Wrist Centralization Using the Dorsal Rotation Flap in Radial Longitudinal Deficiency

Although the role of wrist centralization has been controversial, the surgeon must knowledgeably make surgical decisions for patients with radial longitudinal deficiency, understanding the advantages and disadvantages of centralization techniques. The goals of surgical intervention for correction of radial longitudinal deficiency are to correct the radial deviation deformity of the wrist by centralizing the carpus on the distal end of the ulna, concomitant with balancing the soft tissue structures at the wrist maintaining finger and wrist motion. Wrist centralization is indicated in children with complete absence of the radius with elbow range of motion of greater than 90 degrees, and stable medical condition. This article presents the technique of wrist centralization surgery using a dorsal rotation flap. The wrist capsule is released from the radial side of the ulna, and the carpus is relocated over the distal end of the ulna, with a longitudinal pin placed through the ulna, across the carpus, and between or down the middle ray metacarpal. If the ulna has greater than 30 degrees angulation, a concomitant ulnar osteotomy is performed. Complications can include recurrence, pin problems, stiff digits, and diminished long-term ulnar growth. Long-term splint wear may be necessary to decrease the risk of recurrence. At the present time, an optimal single surgical technique for intervention for this complex congenital deformity has not yet been described.

Insufficiency fracture at the distal diaphysis of the radius after synovectomy combined with the Sauvé-Kapandji procedure in a patient with rheumatoid arthritis

We report here a rare case of insufficiency fracture at the distal diaphysis of the radius in a patient with rheumatoid arthritis (RA) after synovectomy combined with the Sauvé-Kapandji procedure. A 71-year-old woman who had been diagnosed with RA had been consecutively treated with several disease-modifying antirheumatic drugs. She had undergone synovectomy of the right wrist combined with the Sauvé-Kapandji procedure, due to a tendon rupture, 2 years before the current presentation (first visit). Although she had not experienced any recent trauma, the wrist pain had increased after she had lifted up the bedding at the funeral of her friend about 1 month prior to her first visit. Radiographs of her right wrist taken at the second visit showed a fracture at the distal diaphysis of the radius at the level of the excision osteotomy of the distal ulna; however, no displacement of the distal fragment was observed. We immobilized her forearm in a long-arm cast. However, after 3 weeks of cast immobilization, a displacement of the distal fragment was observed. A manual reduction of the displacement was performed and the arm was again immobilized in a long-arm cast. However, 1 week later, a displaced distal fragment was again observed. Subsequently, she received an open reduction and internal fixation using a volar locking plate and screws with an autologous iliac crest bone graft. Bone union was completed by 8 months following the operation.

Distal Humeral Salter Harris (Type II) Fracture Repair by an Ulnar Osteotomy Approach in a Horse

To report repair of a comminuted distal humeral type II Salter-Harris fracture using an ulnar osteotomy approach and locking compression plates (LCP). Case report. A 3-month-old Standardbred filly with a type II Salter-Harris fracture of the distal humerus. Radiographic and computed tomography examinations were performed to assist surgical planning. The distal humeral fracture was approached by an ulnar osteotomy and repaired using a 7-hole broad LCP and screws inserted in lag fashion. The osteotomy was subsequently repaired using a 7-hole narrow LCP. The distal humeral fracture was successfully approached and stabilized by an ulnar osteotomy approach. At 6-month follow-up, the filly was ambulating comfortably with a normal cosmetic appearance. An ulnar osteotomy approach was readily performed and allowed for repair of a type II Salter-Harris fracture of the distal humerus. The equine distal humerus can be accessed readily using an ulnar osteotomy approach. LCPs allow for repair of complicated fractures that have previously been associated with a grave prognosis.

Luxation latérale invétérée post-traumatique de la tête radiale

Chronic dislocation of the radial head in children due to undiagnosed Monteggia's lesion is uncommon. Although it can initially be asymptomatic pain, restriction of movement and secondary arthritic changes may develop as the child grows. The treatment of chronic radial head dislocation remains controversial varying from benign neglect to surgical reduction. Only five chronic lateral Monteggia's lesions have been described with variable surgical results associated with redislocation. A case of chronic post-traumatic lateral dislocation of the radial head in a child treated with ulna osteotomy rigidly fixed and reattachment of the annular ligament is presented. At 2 years follow-up, the clinical result was very satisfying and concentric reduction was maintained. The authors conclude this may be an effective procedure for chronic post-traumatic lateral dislocation of the radial head in children.

Chronic post-traumatic lateral dislocation of the radial head

Chronic dislocation of the radial head in children due to undiagnosed Monteggia's lesion is uncommon. Although it can initially be asymptomatic pain, restriction of movement and secondary arthritic changes may develop as the child grows. The treatment of chronic radial head dislocation remains controversial varying from benign neglect to surgical reduction. Only five chronic lateral Monteggia's lesions have been described with variable surgical results associated with redislocation. A case of chronic post-traumatic lateral dislocation of the radial head in a child treated with ulna osteotomy rigidly fixed and reattachment of the annular ligament is presented. At 2 years follow-up, the clinical result was very satisfying and concentric reduction was maintained. The authors conclude this may be an effective procedure for chronic post-traumatic lateral dislocation of the radial head in children.

External Fixation and Centralization Versus External Fixation and Ulnar Osteotomy: The Treatment of Radial Dysplasia Using the Resolved Total Angle of Deformity

External Fixation and Centralization Versus External Fixation and Ulnar Osteotomy: The Treatment of Radial Dysplasia Using the Resolved Total Angle of Deformity

Extended Olecranon Osteotomy for Removal of a Well-fixed, Total Elbow Ulnar Component

Infection after total elbow arthroplasty (TEA) can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat infection but typically results in significant functional disability. Components may be well fixed and removal may further compromise bone and soft tissue. We present a technique of ulnar osteotomy that facilitates removal of a well-fixed ulnar component and the associated cement mantle while preserving the extensor mechanism. To date, we have performed this procedure on 5 patients. After resection and appropriate antibiotic treatment, 3 patients had reimplantation of a TEA, 1 patient had elbow arthrodesis, and 1 patient elected for a resection arthroplasty. Eradication of infection was achieved in all patients. In suitable patients, this technique can be used to remove a well-fixed ulnar component with the preservation of the extensor mechanism.

External Fixation and Centralization Versus External Fixation and Ulnar Osteotomy: The Treatment of Radial Dysplasia Using the Resolved Total Angle of Deformity

The purpose of this study is to compare preliminary external fixation and centralization to ulnar osteotomy with external fixation for the treatment of radial dysplasia as measured by the resolved total angle (RTA) of deformity. This is a retrospective review of 11 patients (14 limbs) with radial dysplasia. The 3-dimensional deformity was measured by the RTA. Six patients (8 limbs, group 1) underwent correction of their angular deformity with preliminary external fixator distraction followed by centralization. Five patients (6 limbs, group 2) underwent ulnar osteotomy with external fixation. Mean age was 9 years, with a mean follow-up of 41 months. Initial RTA was 112 degrees for group 1, which improved to 38 degrees postoperatively, but worsened to 71 degrees at follow-up. In group 2 the initial RTA was 88 degrees, which improved to 50 degrees, with a worsening to 95 degrees at follow-up. The RTA was found to have high interrater and intrarater reliability. The RTA defines the maximum deformity in radial dysplasia and is a reliable measure. Using the RTA, we showed that preliminary external fixation and centralization are more effective than ulnar osteotomy with external fixation, but both have a high recurrence rate. III.

Effect of surgical technique on radiographic fusion of the anconeus in the treatment of ununited anconeal process

The aim of this study was to determine if internal fixation of the anconeus combined with a proximal ulnar osteotomy was more likely to result in fusion of the anconeus to the ulna compared with a proximal ulnar osteotomy alone. A total of 12 orthopaedic referral clinics reviewed their clinical databases for cases of ununited anconeal process. Demographic and clinical parameters were collected along with radiographic follow-up at a minimum of four weeks. Cases treated with proximal ulnar osteotomy alone were compared with those treated with proximal ulnar osteotomy + internal fixation. Both groups were compared for background and disease variables. We tested for an association between treatment method and whether radiographic anconeal union had occurred. A total of 47 elbows (44 dogs) were identified. Of these, 28 cases (average age 7.6 months) were treated with proximal ulnar osteotomy (of which eight were stabilised with an intramedullary pin) alone. Nineteen cases (average age 7.1 months) were treated with proximal ulnar osteotomy + internal fixation. The two groups were not significantly different in age (P=0.638, Mann-Whitney U test). Fourteen of 28 cases with proximal ulnar osteotomy alone displayed anconeal union at follow-up compared with 16 of 19 cases of proximal ulnar osteotomy + internal fixation, and this difference was statistically significant (P=0.029, Fisher's exact test). These data suggest that use of a lag screw to stabilise and compress the ununited anconeal process in addition to proximal ulnar osteotomy produces a better radiographic outcome. It is argued that radiographic union of the anconeus is likely to be associated with better long-term clinical outcome but further studies are required to confirm this.

WITHDRAWN: Missed Monteggia fracture in children: is annular ligament reconstruction always required?

Ahead of Print article withdrawn by publisher.

Corrective Osteotomies and Osteosynthesis for Supination Contracture of the Forearm in Children

The purpose of this study was to present the authors' experience with corrective osteotomies of the forearm for supination contracture in children. Fourteen patients with supination contracture of the forearm due to brachial plexus lesion (11), poliomyelitis residuals (2), or Monteggia fracture malunion (1) underwent distal ulnar osteotomy without fixation and subsequent midradial osteotomy with plate fixation to produce a position of greater pronation. A minimum of 6 months' follow-up was required to be included in the series. Ten boys and 4 girls whose mean age was 11 years underwent surgery between 1998 and 2006 to correct a supination contracture. The mean preoperative contracture measured 80 degrees of supination. The final mean postoperative correction was 104 degrees, whereas the final mean position of pronation was 24 degrees. Distal ulnar and midradial osteotomies are effective in the treatment of supination deformities of the forearm with little risk of complication or need for additional surgery. Radial fixation is important, but ulnar fixation is not required. Both osteotomies must be complete before plate fixation of the radius to realize maximal correction. Level IV.

Long-Term Clinical and Radiographic Outcomes After Open Reduction for Missed Monteggia Fracture-Dislocations in Children

There have been few reports on the long-term outcomes after the operative treatment of missed Monteggia fracture-dislocations in children. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes after open reduction for the treatment of a missed Monteggia fracture-dislocation. We postoperatively investigated the clinical and radiographic outcomes for twenty-two children with a missed Monteggia fracture. The study group included fourteen boys and eight girls who had had a mean age of ten years (range, four years to fifteen years and eleven months) at the time of open reduction. Each patient had been managed with open reduction of the radial head combined with a posterior bending elongation ulnar osteotomy and anular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of seven years. The postoperative Mayo Elbow Performance Index at the time of follow-up ranged from 65 to 100, with nineteen excellent, two good, one fair, and no poor results. The radial head remained in a completely reduced position in seventeen patients and was subluxated in five patients at the time of the latest follow-up. In four patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were fifteen good, seven fair, and no poor results. A good radiographic result was obtained in all of the patients who had undergone open reduction within three years after the injury or before the age of twelve years, whereas a fair result was obtained in seven of the remaining eight patients. If open reduction for the treatment of a missed Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury, good long-term clinical and radiographic outcomes can be expected.

Inveterate Monteggia Injury. Results of 3 cases with the modified Bell-Tawse procedure

Purpose Monteggia injuries are a rare occurrence (2% of all elbow fractures), and inveterate cases are extremely unusual. We present 3 cases treated by means of open reduction and reconstruction of the annular ligament with a strip of triceps fascia. Materials and methods The mean age of the 3 patients was 7 years (range: 5-9). Two of them were male and all presented with type 1 Bado injuries on the right side. All 3 were treated by means of the Bell Tawse technique as modified by Lloyd-Roberts and Bucknill; one of the patients was also subjected to ulnar osteotomy. Results There were no complications. After a mean follow-up of 35 months (range: 9-84) all patients achieve a functional flexion-extension range. They experienced a slight loss of pronosupination but they reported no restrictions to their activities of daily living or any functional impairment. Conclusions The modified Bell-Tawse technique is an effective method, even if it leads to a slight loss of mobility, especially in terms of pronosupination. The long-term results of this technique are better than those achieved with a late excision of the dislocated radial head.