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A 62-year-old woman visited our hospital one year after a motor vehicle accident complaining of ulnar wrist pain and restricted pronation and supination. Radiographs showed a 35° angular deformity at the ulnar neck. Closing wedge osteotomy was performed using two plates for stabilization. Twenty-four months postoperatively, the osteotomy site united without correction loss and the patient gained adequate pronation and supination. To the best of our knowledge, this represents the first report of corrective osteotomy for the treatment of malunited ulnar neck fracture. Although salvage operations such as ulnar head resection and the Sauvé-Kapandji procedure may provide reasonable results, anatomical repair can be considered as an option.

Background: We identified a subset of patients who had posterolateral rotatory instability (PLRI) following corrective osteotomy for asymptomatic cubitus varus deformity. We aimed to identify risk factors for PLRI in such patients by comparing this subgroup to patients who did not demonstrate PLRI following osteotomy.

Methods: We retrospectively reviewed the medical records and radiographs of 22 patients with cubitus varus that underwent corrective osteotomy at our institution between 2003 and 2010. All patients underwent surgery for cosmetic reasons, and no patient reported functional problems such as PLRI or ulnar nerve symptoms pre-operatively. We sought to identify differences between those that experienced an increase in PLRI after osteotomy (PLRI group) and those that did not (non-PLRI group) with regard to demographics, degree of deformity, amount of surgical correction, and final outcomes.

Results: Five patients had PLRI after osteotomy, and all five subsequently underwent lateral ulnar collateral ligament reconstruction using a triceps tendon graft. No statistically significant difference was observed between the PLRI and non-PLRI groups in terms of demographics, degree of deformity, amount of surgical correction, range of motion, and final Mayo Elbow Performance Index (MEPI) and the Disabilities of Arm, Shoulder, and Hand (DASH) scores. However, the PLRI group had marginally greater medial displacement of the distal fragment.

Conclusions: This study demonstrates that PLRI can become apparent after corrective osteotomy for cubitus varus in the absence of clinical symptoms of instability preoperatively. We suggest that careful examination for PLRI should be performed after surgical correction for cubitus varus deformity, and surgeons should be prepared to proceed with simultaneous reconstruction of the lateral ligaments of the elbow.

The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius.

Background: Three-dimensional computed tomography (3D-CT) imaging has enabled more accurate preoperative planning. The purpose of this study was to investigate the results of a novel, computer-assisted, 3D corrective osteotomy using prefabricated bone graft substitute to treat malunited fractures of the distal radius.

Methods: We investigated 19 patients who underwent the computer-assisted 3D corrective osteotomy for a malunited fracture of the distal radius after the operation was stimulated with CT data. A prefabricated bone graft substitute corresponding to the patient’s bone defect was implanted and internal fixation was performed using a plate and screws. We compared postoperative radiographic parameters of the patient’s operated side with their sound side and analyzed clinical outcomes using Mayo wrist score.

Results: All patients achieved bone union on X-ray imaging at final follow-up. The mean differences of palmar tilt, radial inclination and ulnar variance between the operation side and the sound side were 4.3°, 2.3° and 1.2 mm, respectively. The Mayo wrist score was fair in 4 patients and poor in 15 patients before surgery. At the final follow-up after surgery, the scores improved to excellent in 3 patients, good in 11 patients and fair in 5 patients. There were two patients with correction loss at the final follow-up, but no patient complained of hand joint pain.

Conclusions: We believe that computer-assisted 3D corrective osteotomy using prefabricated bone graft substitute achieved good results because it worked as a guide to the accurate angle.

Corrective osteotomy with callus filling at fracture site for malunion after distal radius fracture is a rare technique, but it achieved a favorable postoperative outcome. The patient, 66-year-old female, visited our hospital 4 months after distal radius fracture. Corrective osteotomy of the distal radius was planned aiming at improving the wrist joint function, and was performed using a volar locking plate, then the bone defect was filled with callus as autogenous bone grafting. At 12 months after surgery, left wrist joint pain and the range of motion have improved, and the Mayo wrist score was excellent. To our knowledge, there has been no study on the treatment of bone defects by filling with callus. Since favorable bone fusion was achieved with callus, this treatment method may overcome the disadvantages of autogenous bone graft, such as pain at the donor region.

The use of wide-awake local anesthesia with no tourniquet (WALANT) in surgical procedures of the hand is well described and extends to tendon surgery, carpal tunnel release, trapeziectomy and phalangeal fracture fixation. Its use has not been described in corrective osteotomies of phalangeal or metacarpal fracture malunion. In our series of five patients who underwent phalangeal and metacarpal osteotomies under WALANT, all of the patients achieved union at a mean of 3.5 months and were satisfied with the results. All digital malrotations were corrected. There was an improvement of motion and grip strength by 24% and 29.3% respectively compared to pre-surgery. Corrective osteotomies under WALANT is a safe and effective means of achieving correction of scissoring. With the patient wide awake and cooperating, precise correction of rotational alignment can be ascertained. Concomitant tenolysis allows motion gains to be made over and above the restoration of rotational alignment.

We report a patient with mature Madelung deformity who underwent radial and ulnar corrective osteotomy using three-dimensional (3D) simulation. An osteotomy model was created using the computer-aided design (CAD) software based on the computed tomography (CT) data. After correcting the ulna, the osteotomy angle of the radius was determined using the location of the lunate as a landmark in the 3D plane created by the longitudinal axis of the corrected ulna. Consequently, the ulna was flexed 3° and shortened by 5 mm, and the radius was extended at 36° and ulna deviated at 25° by open wedge osteotomy. The radial inclinations, volar tilt and ulnar variance were 25°, 45° and 5 mm preoperatively, and improved to 22°, 10° and 0 mm after surgery. At the 18-month follow-up, the patient reported no pain even during sports activity. The preoperative 3D simulation enabled precise preoperative planning and accurate correction of the Madelung deformity.

Level of Evidence: Level V (Therapeutic)