{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T19:49:55Z","timestamp":1740167395427,"version":"3.37.3"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"DOI":"10.13039\/501100002462","name":"Chungnam National University","doi-asserted-by":"crossref","award":["2022"],"award-info":[{"award-number":["2022"]}],"id":[{"id":"10.13039\/501100002462","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003We hypothesized a treatment guideline for ulna\/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend.<\/jats:p><jats:p>\n          Methods\u2003Six patients who met the criteria were retrospectively investigated, and we further categorized \u201cnonunion of both the radius\/ulna\u201d into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4).<\/jats:p><jats:p>\n          Results\u2003Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)\/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius\/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius.<\/jats:p><jats:p>\n          Conclusions\u2003The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius\/ulna were suggested according to the \u201cconcept of stability\u201d based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna.<\/jats:p><jats:p>\n          Level of Evidence\u2003Level IV, retrospective case series.<\/jats:p>","DOI":"10.1055\/s-0043-1776353","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:25:58Z","timestamp":1699403158000},"page":"508-515","source":"Crossref","is-referenced-by-count":0,"title":["A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention"],"prefix":"10.1055","volume":"13","author":[{"given":"Soo Min","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In Ho","family":"Ga","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung Won","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s11751-008-0040-1","article-title":"The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment","volume":"3","author":"A J Logan","year":"2008","journal-title":"Strateg Trauma Limb Reconstr"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/S0266-7681(05)80094-4","article-title":"Fractures of the distal radius and ulna","volume":"20","author":"A Biyani","year":"1995","journal-title":"J Hand Surg [Br]"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s11552-009-9175-x","article-title":"Outcome following acute primary distal ulna resection for comminuted distal ulna fractures at the time of operative fixation of unstable fractures of the distal radius","volume":"4","author":"D E Ruchelsman","year":"2009","journal-title":"Hand (N Y)"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/00005131-199701000-00015","article-title":"Nonunion of distal radial fractures associated with distal ulnar shaft fractures: a report of four cases","volume":"11","author":"M D McKee","year":"1997","journal-title":"J Orthop Trauma"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"2481","DOI":"10.1016\/j.jhsa.2012.07.031","article-title":"Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older","volume":"37","author":"S M Cha","year":"2012","journal-title":"J Hand Surg Am"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.otsr.2018.07.020","article-title":"Conservative treatment of distal ulna metaphyseal fractures associated with distal radius fractures in elderly people","volume":"104","author":"K Sato","year":"2018","journal-title":"Orthop Traumatol Surg Res"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.jhsa.2007.03.010","article-title":"Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture","volume":"32","author":"D G Dennison","year":"2007","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1177\/1558944720922923","article-title":"Treatment modality of distal ulnar head and neck fractures associated with operatively treated distal radius fractures does not affect outcomes","volume":"17","author":"G Glogovac","year":"2022","journal-title":"Hand (N Y)"},{"issue":"23","key":"ref10","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.2106\/JBJS.J.01597","article-title":"A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older","volume":"93","author":"R Arora","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/978-3-642-61261-9","volume-title":"The Comprehensive Classification of Fractures of Long Bones","author":"M E M\u00fcller","year":"1990"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"217","DOI":"10.4103\/ortho.IJOrtho_598_18","article-title":"AO principles of fracture management","volume":"53","author":"J Mukhopadhaya","year":"2019","journal-title":"Indian J Orthop"},{"issue":"09","key":"ref13","doi-asserted-by":"crossref","first-page":"901.e1","DOI":"10.1016\/j.jhsa.2021.08.001","article-title":"Diagnostic criteria and treatment of atypical ulnar fractures associated with prolonged bisphosphonate therapy: multicenter case analysis","volume":"47","author":"Y M Heo","year":"2022","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.injury.2020.10.087","article-title":"Risk factors for atypical forearm fractures associated with bisphosphonate usage","volume":"52","author":"S M Cha","year":"2021","journal-title":"Injury"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1016\/j.injury.2019.10.074","article-title":"Prevention of infection in open fractures: where are the pendulums now?","volume":"51","author":"M Rupp","year":"2020","journal-title":"Injury"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00590-014-1488-y","article-title":"Smoking cessation and bone healing: optimal cessation timing","volume":"25","author":"J Truntzer","year":"2015","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/BF00347342","article-title":"Nonunion","volume":"6","author":"A Naimark","year":"1981","journal-title":"Skeletal Radiol"},{"issue":"S 01","key":"ref18","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1097\/BOT.0000000000001124","article-title":"Absolute versus relative fracture fixation: impact on fracture healing","volume":"32","author":"B L Norris","year":"2018","journal-title":"J Orthop Trauma"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/BOT.0b013e31814d4dc6","article-title":"Metabolic and endocrine abnormalities in patients with nonunions","volume":"21","author":"M R Brinker","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1053\/jhsu.2001.22917","article-title":"Surgical management of delayed union and nonunion of distal radius fractures","volume":"26","author":"D L Fernandez","year":"2001","journal-title":"J Hand Surg Am"},{"key":"ref21","first-page":"21","article-title":"Nonunion of fracture of distal radius: a case report and literature review","volume":"15","author":"K S-CJ Justin","year":"2011","journal-title":"J Orthop Trauma Rehabil"},{"issue":"05","key":"ref22","first-page":"259","article-title":"Nonunions of the distal radius","volume":"31","author":"W A Eglseder Jr","year":"2002","journal-title":"Am J Orthop"},{"key":"ref23","first-page":"S120","article-title":"Nonunion after distal radius fracture: a review [in French]","volume":"35S","author":"P Liverneaux","year":"2016","journal-title":"Hand Surg Rehabil"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2106\/00004623-195335030-00011","article-title":"Colles' fracture; a study of two thousand cases from the New York State Workmen's Compensation Board","volume":"35-A","author":"R W Bacorn","year":"1953","journal-title":"J Bone Joint Surg Am"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/S0363-5023(98)80173-1","article-title":"Un-united fractures of the distal radius: a report of 12 cases","volume":"23","author":"K A Segalman","year":"1998","journal-title":"J Hand Surg Am"},{"issue":"419","key":"ref26","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00003086-200402000-00009","article-title":"Nonunion of distal radius fractures","author":"K J Prommersberger","year":"2004","journal-title":"Clin Orthop Relat Res"},{"key":"ref27","first-page":"713","volume-title":"B\u00fcchel Pseudarthrosen","author":"B Rosen","year":"1992"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0363-5023(86)80045-4","article-title":"Severely comminuted distal radial fracture as an unsolved problem: complications associated with external fixation and pins and plaster techniques","volume":"11","author":"S C Weber","year":"1986","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"207","DOI":"10.2106\/JBJS.21.00850","article-title":"Epidemiology, treatment, and treatment quality of overriding distal metaphyseal radial fractures in children and adolescents","volume":"104","author":"T Laaksonen","year":"2022","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref30","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1177\/17531934211070375","article-title":"Ulnar variance in distal radial fractures: assessment and interpretation","volume":"47","author":"N A Johnson","year":"2022","journal-title":"J Hand Surg Eur Vol"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s00402-021-04247-7","article-title":"Comparing radial lengthening osteotomy with ulnar shortening osteotomy to treat ulnar impaction syndrome after distal radius fracture malunion","volume":"142","author":"H H Ma","year":"2022","journal-title":"Arch Orthop Trauma Surg"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/1558944716685831","article-title":"Ulnar shortening versus distal radius corrective osteotomy in the management of ulnar impaction after distal radius malunion","volume":"13","author":"W R Aibinder","year":"2018","journal-title":"Hand (N Y)"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.jhsa.2013.03.015","article-title":"Isolated ulnar shortening osteotomy for the treatment of extra-articular distal radius malunion","volume":"38","author":"R C Srinivasan","year":"2013","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref34","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s00402-020-03374-x","article-title":"Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures","volume":"140","author":"A Terzis","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1177\/1753193416630525","article-title":"Natural history and factors associated with ulnar-sided wrist pain in distal radial fractures treated by plate fixation","volume":"41","author":"J K Kim","year":"2016","journal-title":"J Hand Surg Eur Vol"}],"container-title":["Journal of Wrist Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1776353.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T23:39:10Z","timestamp":1732923550000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1776353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,7]]},"references-count":34,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2024,11,29]]},"published-print":{"date-parts":[[2024,12]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1776353","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2163-3916","2163-3924"],"issn-type":[{"type":"print","value":"2163-3916"},{"type":"electronic","value":"2163-3924"}],"subject":[],"published":{"date-parts":[[2023,11,7]]}}}