The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients

Abstract

Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the nonoperated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study

“…21,27,28,31 Various techniques for MUSO have been described. 8,21,27,31,42 In a biomechanical study of the closing wedge osteotomy technique at the distal ulnar metaphysis, Greenberg et al 33 demonstrated significant reductions in ulnar load in both static and dynamic phases of wrist motion without significant increases in transverse force across the DRUJ. The mean shortening achieved by the investigators was 2.8 mm in seven cadaver arms.…”

Clinical Study of Wrist Arthroscopy Combined with Oblique Ulnar Shortening Osteotomy in the Treatment of Ulnar Impaction Syndrome

“…The contact area of both ends of V-shaped and trapezoidal osteotomy fractures is large, and the anti-rotation force is enhanced, but the operation is more complicated, the operation time is long, and the two ends of the fracture are prone to malalignment 9 . However, oblique osteotomy is easy to perform, with a large contact area and strong anti-rotation force, so it is widely used in the clinic 10 . Terzis et al 11 treated 17 patients with UIS with oblique USO and followed them up.…”

Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years

“…4 However, these studies often lacked patientreported outcome measures (PROMs), preoperative measurements, 5 or had a small sample size. [8][9][10] Our previous study on 106 patients found beneficial outcomes in patient-reported pain and function 12 months after USO, measured with the Patient-Rated Wrist and Hand Evaluation (PRWHE). 11,12 While shortterm outcomes are favourable, long-term PROMs beyond one year after USO are barely reported.…”

“… 4 However, these studies often lacked patient-reported outcome measures (PROMs), preoperative measurements, 5 or had a small sample size. 8 - 10 …”