Patient-Related Factors Influencing Ulnar-Shortening Osteotomy Outcomes Using the Trimed Dynamic Compression Plate

Abstract

Ulnocarpal impingement can be surgically managed with various shortening osteotomy techniques. The purpose of this study was to retrospectively examine the outcomes of the ulnar-shortening osteotomy technique using the Trimed dynamic compression plate (Valencia, California) and to determine whether results vary among patient-related factors, including smoking status, occupation, preoperative diagnosis, and workers' compensation status. Twenty-seven patients (28 wrists) operated by a single surgeon underwent ulnar shortening over a 4-year span. Radiographic analysis was obtained preoperatively and at an average 24-month follow-up. A subset of 12 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory; the Patient-Rated Wrist Evaluation (PRWE); and the visual analog scale for pain and underwent clinical evaluation for range of motion and strength. Ulnar variance improved in all cases between pre- and postoperative imaging (P<.05). Grip strength and range of motion were found to be 79% and 90% of the contralateral extremity, respectively. Among the examined patient-related factors, patients involved in a workers' compensation claim demonstrated significantly different DASH (average, 56.8 claim vs 26.8 no claim; P=.037) and PRWE (average, 66.0 claim vs 32.8 no claim; P=.008) scores while also showing a trend toward nonunion (3/10 claim vs 1/18 no claim; P=.105). Results of ulnar-shortening osteotomy using the Trimed system at 2-year follow-up show consistent objective improvements in radiographic ulnar variance. Workers' compensation claims may negatively influence outcomes of ulnar shortening, and this factor should be considered in preoperative patient selection and counseling.

Young age, female gender, Caucasian race, and workers’ compensation claim are risk factors for reoperation following arthroscopic ACL reconstruction

“…Although insurance status was accounted for in the multivariate analysis, socioeconomic status and access to care were unable to be controlled for and are factors that previous authors have suggested may be responsible for observed race-related differences [13]. Worker's compensation claims as an independent risk factor for reoperation (OR 1.7, 1.54-1.88) is relatively novel in such a large cohort registry study and is in line with previous authors' reports that workers' compensation is associated with lower subjective outcomes after ACLR [8], mirroring reports across other orthopaedic subspecialties [3,4,60].…”

The Effect of Early Active Mobilization on Union Rate after Ulnar Shortening Osteotomy

“…A large study of 325 USO from South Korea 21 found smoking to be an independent variable to predict nonunion when comparing patients who achieved bony union to those that did not. However, other studies have not found an association with nonunion in smokers, 4,12,15 but they were all smaller studies not designed for subgroup analysis.…”

“…The majority of studies of USO describe 4 to 6 weeks of immobilization before active range of movement and strengthening exercises are started. 4,10,13,15,17,20,21 Therefore, arguably all patients in our study were subject to early active mobilization with a 100% union rate. In a study from Belgium, 5 28 USOs were allowed mobilization immediately postoperatively and had a nonunion rate of 11% (3/28).…”

“…This is comparable to other studies where the median time to union was between 7 and 21 weeks with a range of 4 to 78 weeks. 10,13,15,17 However, as with other studies our patients were only assessed for radiographic union at each clinic visit and union may have been achieved between appointments.…”

Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)

“…[39][40][41][42][43][44][45] Locking plates have shown a nonunion rate of 0 to 14.3%, with an average bone healing duration of 7 to 11 weeks. [46][47][48][49] Although the nonunion rate and the bone healing duration seem to be extended with nonlocking plates, drawing statistical conclusions remains difficult. Furthermore, due to many inconsistencies in definitions of both nonunion and delayed union across various studies, higher-level clinical research is required to unify these definitions and assist surgeons in determining the optimal plate type for the USO procedure.…”