Article
Forearm Corrective Osteotomy pitfalls: What Can Go Wrong Will Go Wrong!
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Authors
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Eva Schwameis
- Herz Jesu Hospital Vienna, Vienna, Austria
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Martin Chochole
- Herz Jesu Hospital Vienna, Vienna, Austria
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: We present two cases of forearm corrective ostotomies with sequelae due to classical mistake with regard to pathology, planning and execution of surgery and the later restitution of function fit to daily life.
Both cases show the sequelae of typical error. These errors in relation to the relevant literature seem to us interesting for the hand surgery community.
Methods: Case 1: (K.B.) was operated at the age of 18: Arthroscopy and ulna resection osteotomy due to a central lesion of TFCC at the right wrist. No further symptoms of impaction syndrome. Ulna shortening ended with a minus of 5 mm. He then suffered from an overload of the DRUG as well as of the brachioradialis muscle with Wartenberg Syndrome. Release of the superficial branch of radial nerve was done in a first step. Followed by radius shortening osteotomy. The patient recovered completely with full forearm rotation and coping with his duty as manual worker.
Case 2: (T.Z.) hurts his right elbow and forearm whilst fleeing out of Afghanistan. He first presented to the doctors in Austria with a painful limitation of the elbow and forearm. The radial head is dislocated. The underlying Monteggia lesion remains unrecognised. He was then operated on performing a double osteotomy of the ulna and radius. To gain relocation of the radial head a double angulated ulna fixation is done and the radius plated in a queer manor. The proximal part of radius due to biceps traction in full supination is fused to the distal part in complete pronation. The now total blockade of forearm rotation is explained to him by the severe starting situation and he was given two options: Radial head resection or the one bone forearm. Asking about which to prefer he came to our institution. Our solution was removal of the hardware and ulna corrective osteotomy with anatomical plate in a first step. Later we did radial derotation osteotomy. He ended up with a nearly full ROM at the elbow and a forearm rotation with 40° prono-supination each.
Results and Conclusions: Both cases show the sequelae of typical error. These errors in relation to the relevant literature seem to us interesting for the hand surgery community.
