Opening versus closing wedge osteotomy of the curved ulna in radial clubhand.

The use of an opening or closing wedge osteotomy to straighten the curved ulna in radial clubhands was simulated by using a specially designed computer program. Sixty-eight lateral x-ray films of curved ulnas in 39 children aged from a few weeks to early adolescence were examined. When lengthening is possible, closing wedge osteotomies yield, at best, only millimeters gain in length. Many will decrease bone length. There is no advantage in using multiple closing wedges. Opening wedges of reasonable angle will lengthen the ulna by 5 mms or more. Some multiple opening wedges can produce slightly better gains in length, but no more than two wedges should be used.