A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

Abstract

Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p<0.05) and average patient satisfaction was 8.7. DASH and PRWE scores improved at three month follow-up (p<0.05). Osteotomy healing time averaged 10.3 weeks, and there were no nonunions. Average discomfort associated with palpation of the plate at final follow-up was 3.3 (using VOS), and one patient requested removal of the hardware. In this short-term follow-up study, the assessed ulna shortening system appears effective and, in general, well tolerated.

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

“…45 Newer, low-profile plates and volar placement of the plate can greatly decrease the incidence of hardware removal. 46 Ulnar shortening osteotomy has few contraindications. Absolute contraindications include established DRUJ arthritis and dorsal DRUJ dislocation.…”

A Dorsal Approach for Ulnar Shortening Osteotomy

“…In our study, PRWE scores are not better, nor worse than PWRE scores reported in other literature (scores ranging from 15 to 42). 6,24,29 Das et al reported no significant difference in PRWE when dorsal plating is compared with volar plating. 6 When a comparison is made between pre-and postoperative PRWE and DASH scores, a significant reduction of scores is seen.…”

“…The lowest DASH score is reported at a follow-up of 11 years. 14,16,18,[24][25][26] After placement of hardware on the ulnar border, postoperative DASH scores range from 21.0 to 37.21. 19,27,28 No study reported on postoperative DASH scores after application of plates on the dorsal surface.…”

“…Previously reported PRWE scores vary from 15 to 40.2 for volarly placed plates. 6,24,29 Only one single study reported on ulnarly placed plates. 27 Das et al described PRWE scores for dorsally placed plates.…”

“…6 When a comparison is made between pre-and postoperative PRWE and DASH scores, a significant reduction of scores is seen. 24,27 Isaacs et al placed their plates volarly and Kim and Park ulnarly. No results on pre-and postoperative PRWE and DASH scores have been reported on dorsally placed plates.…”