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Wide excision of the distal ulna: a multicenter case study
S W Wolfe1, A D Mih, R N Hotchkiss
1Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
The Journal of Hand Surgery
|April 29, 1998
Summary
Wide excision of the distal ulna offers a durable solution for complex forearm issues, including failed reconstructions and neoplasms. This salvage procedure shows good functional outcomes, restoring grip strength and range of motion.
Area of Science:
- Orthopedic Surgery
- Upper Extremity Reconstruction
Background:
- Distal ulna excision for degenerative disease or instability has declined due to complications.
- Previous reconstruction methods for painful distal ulna issues have yielded varied results.
- Salvage options for failed distal ulnar reconstructions or neoplasms are limited.
Purpose of the Study:
- To evaluate the efficacy of wide distal ulna excision as a salvage procedure.
- To assess functional outcomes, pain relief, and stability after wide distal ulna excision.
Main Methods:
- 12 patients underwent wide excision of 25-50% of the distal ulna without soft tissue reconstruction.
- Diagnoses included failed distal radioulnar reconstruction (8), osteomyelitis (1), congenital pseudoarthrosis (1), and neoplasm (2).
- Patients were assessed for instability, function, pain, grip strength, and range of motion at an average of 22 months post-surgery.
Main Results:
- 9 of 12 procedures (75%) yielded good or excellent results.
- One patient had a fair result after osteosarcoma resection; two procedures failed, requiring conversion to a one-bone forearm.
- Grip strength averaged 75% and range of motion 86% of the contralateral side.
Conclusions:
- Wide distal ulna excision is a simple, durable treatment for distal ulna neoplasms and salvage of failed distal radioulnar joint reconstructions.
- This procedure is not recommended for patients with interosseous membrane incompetency or disruption.