Oblique Ulnar Shortening Osteotomy With a New Plate and Compression System

Abstract

Ulnocarpal abutment or the ulnocarpal impaction syndrome occurs when excessive loads exist between the distal ulna and ulnar carpus. This overloading occurs as a result of the distal ulnar articular surface being more distal than the ulnar articular surface of the distal radius. This situation has been termed positive ulnar variance, and it can quickly lead to ulnar-sided wrist degenerative changes and functional losses. Patients often have vague, ulnar-sided complaints of chronic pain and swelling with an insidious onset that does not correlate with any specific traumatic event. Many procedures have been developed to alleviate this condition, but the gold standard for correcting positive ulnar variance is the ulnar shortening osteotomy. The goals of the shortening procedure are to relieve pain and prevent arthritis by reestablishing a neutral or slightly negative ulnar variance. We describe a new plate and compression system in which an oblique ulnar diaphyseal osteotomy is both completed and stabilized through the same jig-based system.

A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

“…The distal ulna was approached subperiosteally between the extensor carpi ulnaris and flexor carpi ulnaris, protecting the dorsal sensory branch of the ulnar nerve. A seven-hole small dynamic compression plate was placed on the volar surface of the ulna 6). The most distal and most proximal screw holes were then drilled along the midline of the ulnar shaft located a few millimeters eccentrically from each other depending on the amount of shortening, and the screws were inserted provisionally, which was helpful for controlling the rotational alignment and plate malposition.…”

Freehand technique with the predrilled hole method for ulnar-shortening osteotomy

“…Shortening with the plate fixation and with an interfragmentary screw added is common in reported studies. 11,15,23,24 We found that the osteotomy junction could be compressed well after fixation of the six side screws in our previous experience with seven-hole plate fixation, and the interfragmentary screw did not seem to be necessary. Therefore we used the six-hole plate for fixation thereafter, and the union rate was still reliable.…”

Ulnar or Radial Shortening Osteotomy With a Single Saw Cut

“…1,2,4,5,8 Several commercially available systems have been developed to permit the reliable performance of 2 parallel osteotomy cuts and the removal of a precise amount of bone, to obtain nearly perfect coaptation and compression of the bone ends and to rigidly fix the osteotomy site. 3,6 However, questions have been raised regarding their cost effectiveness, especially as Sunil et al showed no significant difference between surgical time (p ϭ .71) and union rate (p ϭ .10) between the commercially available Rayhack system (Wright Medical, Arlington, TN) and the freehand technique. 2,9 Labosky and Waggy demonstrated that a single cut with multiple stacked saw blades removes a predictable amount of bone, leaving parallel osteotomy surfaces.…”

“…The indications for ulnar shortening include ulnocarpal abutment, triangular fibrocartilage injuries, posttraumatic radial shortening, attritional lunotriquetral ligament tears, and incongruity and early arthritis of the distal radioulnar joint. [1][2][3][4][5] Radial shortening may be desired for the treatment of Kienböck's disease. 3 Many surgeons prefer an oblique osteotomy at 45°, 6,7 as the reported nonunion rate of 0 to 4% compares favorably with the 8% to 15% nonunion rate after transverse osteotomies.…”

“…[1][2][3][4][5] Radial shortening may be desired for the treatment of Kienböck's disease. 3 Many surgeons prefer an oblique osteotomy at 45°, 6,7 as the reported nonunion rate of 0 to 4% compares favorably with the 8% to 15% nonunion rate after transverse osteotomies. 8 Oblique osteotomies also heal quicker than do transverse osteotomies, with a mean healing time of 11 weeks and 21 weeks, respectively.…”