Acute shortening of upper extremity in orthopaedic patients: a scoping review.

Abstract

Purpose: Acute shortening of the upper extremity could be used in patients with segmental bone loss or large soft tissue defects. The study aimed to review available evidence about acute shortening procedures of the upper extremities to evaluate the common indications and tolerable shortening length.

Methods: All clinical studies involving acute shortening procedures of the upper extremity were considered eligible for inclusion. PubMed, Embase, Web of Science and Cochrane Library for English-language articles from inception to December 2024 were searched. Two reviewers independently charted data from each eligible article.

Results: Out of 730 studies screened, 35 articles met the inclusion criteria. There were 24 case series and 11 case reports containing 355 acute shortening procedures. Acute shortening was reported in 12 articles for amputation, 15 for fracture nonunion, 2 for fresh or delayed fracture, 2 for tumor, 2 for brachial plexus injury and 2 for forearm deformity. The maximum shortening for replantation was 10 cm in the forearm and 12 cm in the humerus. Shortening up to 2.9 cm and 8 cm for fracture nonunion were reported for the forearm and humerus, respectively.

Conclusions: The main indications for acute shortening of the upper limb were amputation for replantation and fracture nonunion. Aggressive bony shortening was recommended in the setting of amputations. Controversies existed about the tolerated shortening length for both the forearm and humerus.