title: Wide excision of the distal ulna: a multicenter case study.
abstract: Excision of the distal ulna to treat degenerative disease or instability has fallen into disfavor following reports of radioulnar impingement, carpal instability, and distal ulnar instability. Alternative procedures for reconstruction of the painful distal ulna have been developed to address these problems; the results have been generally favorable. When faced with distal ulnar reconstruction that has failed after multiple surgical procedures, or a distal ulnar neoplasm, the surgeon is left with few treatment options. Creation of a one-bone forearm, free fibular transfer, and allograft replacement have been attempted, with mixed outcomes. We report the results of 5 men and 7 women who underwent wide excision of the distal ulna, defined as surgical excision of 25% to 50% of the ulnar length. The diagnosis was failed distal radioulnar reconstruction or excision in 8 patients, osteomyelitis in 1, congenital pseudoarthrosis of the radius in 1, and neoplasm in 2. No soft tissue reconstruction was performed. Patients were examined at an average of 22 months after surgery for radiocarpal and radioulnar instability, functional outcome, pain relief, grip strength, and range of motion. Nine of the 12 procedures resulted in good or excellent results; 1 patient had a fair result after resection for osteosarcoma, and the procedure in 2 patients failed, requiring conversion to a one-bone forearm. Grip strength was restored to 75% of the normal side and range of motion was restored to 86% of the normal side. Wide excision of the distal ulna without soft tissue reconstruction is a simple and durable treatment of neoplasms of the distal ulna or salvage of the failed reconstruction of the distal radioulnar joint. We do not recommend its use in patients with incompetency or disruption of the interosseous membrane.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Wolfe
authors.forename: A D
authors.initials: AD
authors.lastname: Mih
authors.forename: R N
authors.initials: RN
authors.lastname: Hotchkiss
authors.forename: R W
authors.initials: RW
authors.lastname: Culp
authors.forename: T R
authors.initials: TR
authors.lastname: Keifhaber
authors.forename: D J
authors.initials: DJ
authors.lastname: Nagle
mesh_terms: D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000209:etiology / Q000601:surgery; D001859:Bone Neoplasms / Q000601:surgery; D016025:Bone Transplantation / Q000379:methods; D002348:Carpal Bones / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery; D010146:Pain / Q000503:physiopathology; D011183:Postoperative Complications; D011403:Pronation / Q000502:physiology; D011542:Pseudarthrosis / Q000151:congenital / Q000601:surgery; D011884:Radius / Q000473:pathology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013484:Supination / Q000502:physiology; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery