RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0040-1702959
Osteotomias de encurtamento da ulna: A nossa experiência[*]
Artikel in mehreren Sprachen: português | English
Resumo
Objetivo O objetivo do presente estudo foi avaliar os resultados clínicos e radiográficos da nossa casuística relativamente a osteotomias de encurtamento da ulna, bem como rever sumariamente a patologia, as indicações e as opções cirúrgicas do conflito ulnocárpico.
Métodos Realizamos uma análise retrospectiva de pacientes consecutivos que foram tratados com osteotomia de encurtamento da ulna entre janeiro de 2012 e junho de 2017 no nosso hospital. Avaliamos clinicamente a dor, amplitude articular, força da garra e resultados funcionais recorrendo ao questionário quick-DASH. Medimos radiograficamente a variância ulnar pré- e pós-operatória e o encurtamento realizado.
Resultados Identificamos oito pacientes operados, tendo sido possível avaliar sete destes. Nesta população, obtivemos uma diminuição da dor (escala analógica visual [VAS, na sigla em inglês] de 7 para 2.6, p < 0,05), uma diminuição do quick-DASH (64 para 28, p < 0,05) e constatamos uma diminuição da amplitude articular ∼ 7° para a flexão (p = 0.2), de 5.5° para a supinação (p = 0,3), bem como diminuição da força da garra para cerca de 86% do lado contralateral (p = 0,07). A variância ulnar foi alterada de uma média de + 5.5 mm para −1.1 mm (p < 0,05). Dois em 8 pacientes (25%) apresentaram sintomatologia relacionada com a placa, sendo que um deles foi submetido a nova intervenção para extração do material.
Conclusões A osteotomia de encurtamento da ulna é um procedimento cirúrgico eficaz, tanto no tratamento do conflito ulnocárpico, como na descarga da ulna. Os resultados apresentados vão ao encontro aos demais publicados na literatura, tendo-se obtido bons resultados clínicos e radiográficos.
* Trabalho desenvolvido no Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal.
Publikationsverlauf
Eingereicht: 12. August 2019
Angenommen: 29. November 2019
Artikel online veröffentlicht:
06. April 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações
Ltda
Rio de Janeiro, Brazil
-
Referências
- 1 Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2008; 33 (09) 1669-1679
- 2 Viegas SF. The lunatohamate articulation of the midcarpal joint. Arthroscopy 1990; 6 (01) 5-10
- 3 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26 (04) 549-557
- 4 Milch H. Cuff resection of the ulna for malunited Colles' fracture. J Bone Joint Surg Am 1941; 23: 311-313
- 5 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (01) 46-53
- 6 Loh YC, Van Den Abbeele K, Stanley JK, Trail IA. The results of ulnar shortening for ulnar impaction syndrome. J Hand Surg Br 1999; 24 (03) 316-320
- 7 El-Karef E. Staged reconstruction for malunited fractures of the distal radius. J Hand Surg Br 2005; 30 (01) 73-78
- 8 Orfale AG, Araújo PMP, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire. Braz J Med Biol Res 2005; 38 (02) 293-302
- 9 Sagerman SD, Zogby RG, Palmer AK, Werner FW, Fortino MD. Relative articular inclination of the distal radioulnar joint: a radiographic study. J Hand Surg Am 1995; 20 (04) 597-601
- 10 Tolat AR, Sanderson PL, De Smet L, Stanley JK. The gymnast's wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg Br 1992; 17 (06) 678-681
- 11 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
- 12 Werner FW, Palmer AK, Fortino MD, Short WH. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am 1992; 17 (03) 423-428
- 13 Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am 1984; 9 (05) 681-682
- 14 Fischer J, Thompson NW, Harrison JW. Triangular Fibrocartilage Complex Lesions—A Classification. London: Springer London; 2014: 371-372
- 15 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br 1997; 22 (06) 719-723
- 16 Cerezal L, del Piñal F, Abascal F, García-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002; 22 (01) 105-121
- 17 Tomaino MM. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg Am 2000; 25 (02) 352-357
- 18 Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg Am 2005; 30 (04) 719-726
- 19 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (07) 1501-1507
- 20 Hollevoet N, Verdonk R, Van Maele G. The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. J Hand Surg Br 2006; 31 (02) 221-225
- 21 Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. J Hand Surg Am 1992; 17 (04) 731-737
- 22 Tomaino MM. Results of the wafer procedure for ulnar impaction syndrome in the ulnar negative and neutral wrist. J Hand Surg [Br] 1999; 24 (06) 671-675
- 23 Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am 2000; 25 (01) 55-60
- 24 Nishizuka T, Tatebe M, Hirata H, Shinohara T, Yamamoto M, Iwatsuki K. Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain. Bone Joint J 2013; 95-B (12) 1687-1696
- 25 Rayhack JM, Gasser SI, Latta LL, Ouellette EA, Milne EL. Precision oblique osteotomy for shortening of the ulna. J Hand Surg Am 1993; 18 (05) 908-918
- 26 Darlis NA, Ferraz IC, Kaufmann RW, Sotereanos DG. Step-cut distal ulnar-shortening osteotomy. J Hand Surg Am 2005; 30 (05) 943-948
- 27 Moermans A, Degreef I, De Smet L. Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (06) 310-314
- 28 Doherty C, Gan BS, Grewal R. Ulnar shortening osteotomy for ulnar impaction syndrome. J Wrist Surg 2014; 3 (02) 85-90
- 29 Fufa DT, Carlson MG, Calfee RP, Sriram N, Gelberman RH, Weiland AJ. Mid-term results following ulna shortening osteotomy. HSS J 2014; 10 (01) 13-17
- 30 Rajgopal R, Roth J, King G, Faber K, Grewal R. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (N Y) 2015; 10 (03) 535-540