间隙截骨术与背侧开口楔形截骨术治疗桡骨远端关节外畸形愈合及掌侧锁定钢板内固定的临床和影像学结果

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-01-01 DOI:10.1016/j.jhsg.2024.09.001

Suhas Sondur MS (Ortho) , Anil K. Bhat MS (Ortho), DNB (Ortho) , Shyamasunder Bhat N MS (Ortho), DNB (Ortho)

{"title":"间隙截骨术与背侧开口楔形截骨术治疗桡骨远端关节外畸形愈合及掌侧锁定钢板内固定的临床和影像学结果","authors":"Suhas Sondur MS (Ortho) , Anil K. Bhat MS (Ortho), DNB (Ortho) , Shyamasunder Bhat N MS (Ortho), DNB (Ortho)","doi":"10.1016/j.jhsg.2024.09.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Metaphyseal corrective osteotomy and fixed-angle volar locking plate fixation have reduced the need for additional bone grafting in symptomatic distal radius malunions. This study evaluated the outcomes of gap versus dorsal opening wedge and locking plate fixation without bone grafts for distal radius malunions and the correlation between the osteotomy defect and the osteotomy’s distance from the articular surface with the union time.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 62 patients who underwent corrective osteotomy between 2010 and 2021. Gap osteotomy (n = 44) was performed to correct the coronal deformity predominantly, whereas an opening wedge osteotomy (n = 18) was performed to correct the sagittal deformity. No bone graft was used in any patient. Radiological outcomes comprised of correction of radial height, inclination, ulnar variance, volar tilt and the correlation between the osteotomy defect and the distance from the distal radial articular surface with the union time. The functional assessment comprised the disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores.</div></div><div><h3>Results</h3><div>All patients had a union of the osteotomy and statistically significant improvement in the radial height, inclination, ulnar variance, and tilt, irrespective of the osteotomy technique (<em>P</em> < .05). The mean defect length of the osteotomy, the time to the union, and the distance of the osteotomy were 4.7 mm (1–8.3 mm), 11.7 weeks (5–24 weeks), and 13.9 mm (1.6–35.8 mm), respectively. Time taken for union showed a weak positive correlation with the defect length of the osteotomy and no correlation with the distance of the distal osteotomy site from the articular surface. Opening wedge osteotomies took less time than the gap osteotomies. The mean postoperative disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores were 6.89 and 12.18, respectively.</div></div><div><h3>Conclusions</h3><div>Corrective osteotomy and fixed-angle volar plate fixation for distal radius malunion provide satisfactory union rates and clinical and radiological outcomes even without bone graft, irrespective of the osteotomy type, size, or location. However, length of the osteotomy defect influenced the union time.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 14-22"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical and Radiographic Outcomes of Gap Osteotomy Versus Dorsal Opening Wedge Osteotomy for Extra-Articular Distal Radius Malunion and Internal Fixation Using a Volar Locking Plate Without Bone Graft\",\"authors\":\"Suhas Sondur MS (Ortho) , Anil K. Bhat MS (Ortho), DNB (Ortho) , Shyamasunder Bhat N MS (Ortho), DNB (Ortho)\",\"doi\":\"10.1016/j.jhsg.2024.09.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Metaphyseal corrective osteotomy and fixed-angle volar locking plate fixation have reduced the need for additional bone grafting in symptomatic distal radius malunions. This study evaluated the outcomes of gap versus dorsal opening wedge and locking plate fixation without bone grafts for distal radius malunions and the correlation between the osteotomy defect and the osteotomy’s distance from the articular surface with the union time.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 62 patients who underwent corrective osteotomy between 2010 and 2021. Gap osteotomy (n = 44) was performed to correct the coronal deformity predominantly, whereas an opening wedge osteotomy (n = 18) was performed to correct the sagittal deformity. No bone graft was used in any patient. Radiological outcomes comprised of correction of radial height, inclination, ulnar variance, volar tilt and the correlation between the osteotomy defect and the distance from the distal radial articular surface with the union time. The functional assessment comprised the disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores.</div></div><div><h3>Results</h3><div>All patients had a union of the osteotomy and statistically significant improvement in the radial height, inclination, ulnar variance, and tilt, irrespective of the osteotomy technique (<em>P</em> < .05). The mean defect length of the osteotomy, the time to the union, and the distance of the osteotomy were 4.7 mm (1–8.3 mm), 11.7 weeks (5–24 weeks), and 13.9 mm (1.6–35.8 mm), respectively. Time taken for union showed a weak positive correlation with the defect length of the osteotomy and no correlation with the distance of the distal osteotomy site from the articular surface. Opening wedge osteotomies took less time than the gap osteotomies. The mean postoperative disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores were 6.89 and 12.18, respectively.</div></div><div><h3>Conclusions</h3><div>Corrective osteotomy and fixed-angle volar plate fixation for distal radius malunion provide satisfactory union rates and clinical and radiological outcomes even without bone graft, irrespective of the osteotomy type, size, or location. However, length of the osteotomy defect influenced the union time.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>\",\"PeriodicalId\":36920,\"journal\":{\"name\":\"Journal of Hand Surgery Global Online\",\"volume\":\"7 1\",\"pages\":\"Pages 14-22\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery Global Online\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589514124001865\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery Global Online","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589514124001865","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目的：在有症状的桡骨远端畸形愈合中，采用干骺端矫正截骨和固定角度掌侧锁定钢板固定可以减少额外植骨的需要。本研究评估了骨间隙与背侧开口楔形锁定钢板固定治疗桡骨远端畸形愈合的效果，以及截骨缺损、截骨距关节面距离与愈合时间的关系。方法回顾性分析2010年至2021年间行矫正截骨术的62例患者。间隙截骨术（n = 44）主要用于纠正冠状畸形，而开放楔形截骨术（n = 18）用于纠正矢状畸形。所有患者均未使用骨移植。放射学结果包括桡骨高度、倾斜度、尺侧方差、掌侧倾斜度的矫正以及截骨缺损与桡骨远端关节面距离与愈合时间的相关性。功能评估包括手臂、肩部和手部残疾问卷和患者评定的手腕评估评分。结果所有患者截骨愈合，且不论采用何种截骨技术，桡骨高度、倾斜度、尺侧方差和倾斜度均有统计学意义上的改善(P <；. 05)。截骨缺损长度平均4.7 mm (1 ~ 8.3 mm)，愈合时间平均11.7周（5 ~ 24周），截骨距离平均13.9 mm （1.6 ~ 35.8 mm）。愈合时间与截骨缺损长度呈弱正相关，与远端截骨点离关节面距离无相关性。开放楔形截骨术比间隙截骨术时间短。术后手臂、肩部和手部残疾问卷的平均得分和患者评定的手腕评估得分分别为6.89分和12.18分。结论不论截骨方式、截骨大小、截骨位置如何，桡骨远端畸形愈合采用矫正截骨联合掌侧固定角度钢板固定均可获得满意的愈合率和临床及影像学结果。然而，截骨缺损的长度影响愈合时间。研究类型/证据水平治疗性IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Clinical and Radiographic Outcomes of Gap Osteotomy Versus Dorsal Opening Wedge Osteotomy for Extra-Articular Distal Radius Malunion and Internal Fixation Using a Volar Locking Plate Without Bone Graft

Purpose

Metaphyseal corrective osteotomy and fixed-angle volar locking plate fixation have reduced the need for additional bone grafting in symptomatic distal radius malunions. This study evaluated the outcomes of gap versus dorsal opening wedge and locking plate fixation without bone grafts for distal radius malunions and the correlation between the osteotomy defect and the osteotomy’s distance from the articular surface with the union time.

Methods

We retrospectively reviewed 62 patients who underwent corrective osteotomy between 2010 and 2021. Gap osteotomy (n = 44) was performed to correct the coronal deformity predominantly, whereas an opening wedge osteotomy (n = 18) was performed to correct the sagittal deformity. No bone graft was used in any patient. Radiological outcomes comprised of correction of radial height, inclination, ulnar variance, volar tilt and the correlation between the osteotomy defect and the distance from the distal radial articular surface with the union time. The functional assessment comprised the disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores.

Results

All patients had a union of the osteotomy and statistically significant improvement in the radial height, inclination, ulnar variance, and tilt, irrespective of the osteotomy technique (P < .05). The mean defect length of the osteotomy, the time to the union, and the distance of the osteotomy were 4.7 mm (1–8.3 mm), 11.7 weeks (5–24 weeks), and 13.9 mm (1.6–35.8 mm), respectively. Time taken for union showed a weak positive correlation with the defect length of the osteotomy and no correlation with the distance of the distal osteotomy site from the articular surface. Opening wedge osteotomies took less time than the gap osteotomies. The mean postoperative disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores were 6.89 and 12.18, respectively.

Conclusions

Corrective osteotomy and fixed-angle volar plate fixation for distal radius malunion provide satisfactory union rates and clinical and radiological outcomes even without bone graft, irrespective of the osteotomy type, size, or location. However, length of the osteotomy defect influenced the union time.