Oblique ulnar shortening osteotomy by a single saw cut.

Ulnar shortening osteotomy is an effective treatment in patients with ulnar impaction syndrome. Accurate shortening and bony apposition can be obtained for a wide range of shortening lengths with a single-cut osteotomy technique. The saw kef produced by a single saw pass cuts a bony defect with parallel walls. The amount of shortening produced by using standard power bone saws can be increased by stacking as many as three blades together on the saw and by varying the angle at which the cut is made. The amount of shortening is a function of the angle at which the cut is made. The amount of shortening can be increased by a factor of twice the saw kerf if the cut is made at 60 degrees. We tabulated the shortening expected from over 100 combinations of power saw blades and cut angles. Using a series of experimental osteotomies, we demonstrated that the single-cut technique produces a more predictable amount of shortening than the technique of using two parallel cuts to remove a cuff of bone. The single-cut technique is useful for shortening any long bone.

Forearm fracture plates: to remove or not to remove.

Eighty dynamic compression plates used to fix fractures of the radius and/or ulna were removed from 51 of 98 adult patients. Thirty-seven patients had plates removed electively. Fourteen patients had plates removed for clinical reasons. The average time from insertion to removal was 13.6 months, with a range from 4.4 to 36 months. Only one refracture occurred through the unhealed both bone forearm fracture site in a patient whose plate was taken out 6 months after surgery. One refracture also occurred through the proximal screw hole of a still implanted ulna plate that had been inserted 3 years earlier. Leaving a plate in for the remaining life of a young patient cannot be considered a benign decision considering the persisting chance for refracture and the potential complications from prolonged exposure to metal corrosion complexes and metal ions.

Apparent weakness of median and ulnar motors in radial nerve palsy.

Muscle testing of a patient with radial nerve palsy can incorrectly suggest median and ulnar weakness because of a decreased ability to stabilize the thumb and wrist. Ten adult volunteers had radial nerve blocks and their strengths were quantitatively evaluated before and after blocking for grip, key pinch, isolated thumb adduction (adduction pinch), thumb palmar abduction, finger flexion, and flexor pollicis longus (FPL) function. Data were analyzed by paired t test (p less than 0.05). All composite motions that required stabilization of the wrist or thumb showed marked weakness after the radial nerve block (grip decreased 77%, key pinch decreased 33%, and thumb palmar abduction strength decreased 53%). The strength of adduction pinch, finger flexion, and FPL showed no significant decreases after the radial nerve block. Since adduction pinch and isolated FPL function can be easily tested clinically, they should be examined to prevent confusion with median and ulnar problems.