Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck’s Disease

신영호,김지형,공현식,이승환,조민준,백구현 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.3

Background: Radius osteotomies showed favorable clinical outcome in Kienböck's disease. However, few articles have been published on the long-term outcome of lateral wedge osteotomy of the radius in patients with advanced stage Kienböck's disease. Methods: Eleven patients with Lichtman stage IIIB/IV Kienböck's disease (group A; mean follow-up period, 86.1 months; range, 48 to 163 months) and 14 patients with Lichtman stage IIIA Kienböck's disease (group B; mean follow-up period, 85.1 months; range, 49 to 144 months) underwent radial wedge osteotomy between August 2004 and August 2012. Radiological changes of the lunate and radiocarpal joint were compared between two groups after osteotomy. The wrist flexion/extension angle, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were evaluated preoperatively and at the final follow-up. The Nakamura Scoring System (NSSK) was used for comprehensive understanding of radiological and clinical outcomes. Results: Nine patients of group A and 11 patients of group B showed radiological improvement in the lunate regarding sclerosis, cystic changes, or fragmentation. No patients showed progression of arthritic changes in radiocarpal and midcarpal joints. The wrist flexion/extension angle, grip strength, and DASH score were significantly improved in both groups after operation, but intergroup difference was not statistically significant at the final follow-up (p = 0.149, p = 0.267, and p = 0.536, respectively). The mean NSSK was 21.6 (range, 15 to 27) in group A and 21.8 (range, 15 to 26) in group B. Conclusions: Radial wedge osteotomy yielded excellent radiological and functional outcomes in advanced stages of Kienböck's disease and these results were comparable to those of Lichtman stage IIIA disease. This technique could be a useful alternative to salvage procedures in the treatment of Lichtman stage IIIB/IV Kienböck's disease without severe radiocarpal arthritis.

Distal Radius Osteotomy for the Treatment of Kienböck's Disease

Hong Jun Park(박홍준),Jesse Bernard Jupiter(제씨 주피터) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.8

목적: ⅢB나 Ⅳ기와 같이 병이 진행된 경우를 제외한 경우의 수근부 월상골의 무혈성 괴사의 치료에서 원위 요골의 단순 절골술 및 내고정술을 시행하고, 이 수술 전후에서의 임상적 및 방사선적 결과를 평가하고자 후향적 연구를 하였다. 대상 및 방법: 1995년 이후에 월상골의 무혈성 괴사에서 원위 요골 절골술 및 내고정술을 시행한 16예 중 1년 이상 추시 관찰이 가능했던 12예에서 동통, 운동 범위, 파악력 등으로 수술 후 결과를 평가하였다. 8예는 Lichtman Ⅱ기였으며, 4예는 ⅢA기였다. 평균 추시 기간은 2.5년이었으며, 평균 척골 음위는 1.3 ㎜였다. 결과: 4예에서는 동통이 완전히 소설되었으며, 나머지 8예에서는 심한 노동시에 약한 동통이 남아 있었다. 수근 관절의 운동 범위는 수술 전 81°에서 수술 후 99°로 호전되었으며(p=0.0020), 파악력 또한 의미 있게 호전되었다(p=0.0005). 불유합이나 감염, 관절 운동의 제한과 같은 합병증이 없었다. 결론: 원위 요골 단순 절골술 및 내고정술은 수근 관절을 보존하면서 수근부의 운동 범위를 증가시키고 월상골의 형태를 유지할 수 있었으며, 초기의 월상골 무혈성 괴사에서 사용될 수 있는 훌륭한 치료 술식으로 사료된다. Purpose: This study evaluated the clinical and radiographic results of radial osteotomy and internal fixation for the management of Kienbock's disease excluding the advanced stages Ⅲ8 and Ⅳ. Materials and Methods: Distal radial osteotomy and internal fixation with limited contact-dynamic compression plate (LC-DCP) has been used to treat 16 cases of Kienbock's disease since 1995. Twelve cases with a minimum follow-up of 1 year were included in this study. There were 6 men, one of them with bilateral involvement, and five patients were women. The average age at the time of surgery was 31 years (range, 19-52 years). The average follow-up was 2.5 years. Eight cases were stage Ⅱ and four cases were stage ⅢA. The average ulnar minus was 1.3 ㎜. Results: Four patients were relieved of pain and the others had mild pain when performing strenuous activity. The wrist ranges of motion increased with surgery from 81° to 99° and grip strength improved significantly. There were no complications such as nonunion, limitation of joint motion or infection. Conclusion: A distal radius osteotomy is an excellent procedure that does not violate the carpal joint and thus preserves the lunate bone architecture and ROM of the wrist.

Single oblique osteotomy for correction of congenital radial head luxation with concurrent complex angular limb deformity in a dog: a case report

Jun-Hyung Kim,Jaeyong Song,Sun-Young Kim,Byung-Jae Kang 대한수의학회 2020 Journal of Veterinary Science Vol.21 No.4

A 5-month old Shih Tzu was diagnosed with congenital elbow luxation and uniapical complex angular deformity of the radius. Single radial oblique and dynamic ulnar osteotomies were performed, using patient-specific 3D-printed osteotomy guide. External skeletal fixation was maintained for three weeks to prevent re-luxation of elbow joint. Three months after the surgery, objective gait analysis indicated markedly improved limb function. In addition, radiograph showed improved congruity of elbow joint and appropriate bone healing. In dogs with congenital radial head luxation and concurrent complex angular deformity, a single oblique osteotomy might be a viable option to preserve bone length and correct the luxation of elbow joint.

Circular Tibial Tuberosity Advancement for Cranial Cruciate Ligament Rupture in a Dog

한철규,강진수,이동빈,이해범,김남수,허수영 한국임상수의학회 2019 한국임상수의학회지 Vol.36 No.5

A 8-year-old, intact female, 2.1 kg, yorkshire terrier dog was referred to Animal Medical Center, Chonbuk National University due to right hindlimb lameness. Orthopedic examinations revealed pain during extension and flexion on stifle joint, positive cranial drawer sign, positive tibial compression test and patella luxation. Radiography showed the cranial displacement of right tibia with mildly increasing the synovial volume. The surgical procedure involved radial osteotomy of the proximal tibia and fixation by 1.2 T-locking plate. At two weeks after surgery, the patient was able to weight-bearing and gait gradually improved. This case report describes circular Tibial Tuberosity Advancement (cTTA) surgical technique and the successful surgical repair of cranial cruciate ligament rupture a dog.

Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult

Sang Won Moon,Youngbok Kim,Young-Chang Kim,Ji-Wan Kim,Taiyeon Yoon,Seung-Chul Kim 대한견주관절의학회 2018 대한견주관절학회지 Vol.21 No.1

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia , we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

Surgical Correction of an Antebrachial Deformity with Severe External Rotation in Two Dogs

윤헌영,노미영,정순욱 한국임상수의학회 2011 한국임상수의학회지 Vol.28 No.3

Two dogs presented to the Dueckso Animal Hospital with a history of intermittent lameness of the left forelimb. On physical examination, a visible antebrachial deformity that resulted in gross external rotation of approximately 90o was observed in two dogs. Medial-lateral radiographic views revealed distal ulnar subluxation, cranial bowing of the radius, radial and ulnar shortening, and external rotation of the paw. A distal ulnar ostectomy and distal radial closing wedge osteotomy were performed in two dogs. A proximal ulnar osteotomy was performed, adjacent to the elbow joint in case 1. Then, the osteotomized site was supported with an intramedullary pin. A T-plate and cortical screws were applied to the proximal and distal radial segments after derotating the distal segment internally. Postoperative radiographic view verified the correction of the angular deformity in two dogs. The follow-up was completed by physical examination 6 and 10 months after surgery respectively. There was no evidence of lameness of the left forelimb in two dogs. Gross observation of the limb revealed an apparent appropriate correction of the rotational and angular deformity in two dogs.