Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

McBeath, Rowena; Katolik, Leonid I.; Shin, Eon K.

doi:10.1016/j.jhsa.2012.07.019

Cited by 22 publications

(18 citation statements)

References 15 publications

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“…Ulnar shortening osteotomy (USO) is a widely accepted surgical treatment option 43 for ulnar-sided wrist pain associated with multiple conditions, including triangular 44 fibrocartilage complex (TFCC) injuries, lunotriquetral (LT) ligament tears, and ulnar 45 impaction syndrome (UIS). [1][2][3][4] An USO can effectively treat pain associated with 46 TFCC injury, even in the absence of ulnar positive variance, and particularly when 47 prior TFCC debridement or repair has failed. [2] Ulnar impaction syndrome is the 48 direct result of positive static or dynamic ulnar variance, which causes the distal 49 ulna to abut against the ulnar carpus.…”

Section: Introduction 42mentioning

confidence: 99%

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Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate

Gaspar

Kane

Zohn

et al. 2016

The Journal of Hand Surgery

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PURPOSE 5To examine potential risk factors for development of delayed or nonunion following 6 elective ulnar shortening osteotomy using a dedicated osteotomy plating system. 7 8 METHODS 9We performed a retrospective review of all patients who underwent elective ulnar 10 shortening using the TriMed single osteotomy dynamic compression plating system 11 by one of two fellowship-trained hand surgeons over a five-year period. 12Demographic data and medical, surgical, and social histories were reviewed. Time to 13 bony union was determined radiographically by a blinded reviewer. Bivariate 14 statistical analysis was performed to examine the effect of explanatory variables on 15 the time to union and the incidence of delayed or nonunion. Those variables 16 associated with the development of delayed or nonunion were used in a 17 multivariate logistic regression model. Complications, including the need for 18 additional surgery, were also recorded. 19 20 RESULTS 21Seventy-two ulnar shortening osteotomy procedures were performed in 69 22 patients. Delayed union, defined as ≥ 6 months to union, occurred in 8/72 cases 23 (11%). Four of 72 (6%) surgeries resulted in nonunions, all of which required 24 additional surgery. Hardware removal was performed in 13/72 (18%) of cases. 25Time to union was significantly increased in smokers (6+/-3 months) versus non-26 smokers (3 +/-1 months). On multivariate analysis, diabetics and active smokers 27 demonstrated a significantly higher risk of developing delayed union or nonunion. 28Patient age, sex, body mass index, thyroid disease, workers compensation status, 29 alcohol use, and amount smoked daily did not have an effect on the time to union or 30 the incidence of delayed or nonunion. 31 32 CONCLUSIONS 33Despite the use of an osteotomy-specific plating system, smokers and diabetics were 34 at significantly higher risk for both delayed union and nonunion following elective 35 ulnar shortening osteotomy. Other known risk factors for suboptimal bony healing 36were not found to have a deleterious effect. 37 38 LEVEL OF EVIDENCE 39Prognostic Level III 40

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Section: Introduction 42mentioning

confidence: 99%

“…[2, 4] By shortening and 51 leveling the ulna, USO offloads the ulnar carpus from the distal ulna, thereby 52 relieving pain [1]. Reported outcomes following USO are generally favorable, although complications 55…”

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confidence: 99%

Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate

Gaspar

Kane

Zohn

et al. 2016

The Journal of Hand Surgery

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“…This abutment results in compromise of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, abnormal wear on the distal ulna, and sometimes disruption of the lunotriquetral ligament. 1,2 The etiology of this condition is related to a relatively longer ulnar height compared with the radius at the wrist. This is seen with either an abnormally long ulna (i.e., idiopathic positive ulnar variance) or a shortened radius (i.e., fracture malunion, Essex-Lopresti, or premature physis closure).…”

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confidence: 99%

“…Patients often present with progressive ulnar-sided wrist pain that worsens with ulnar deviation, pronation, and power grip. 1,2 Signs of ulnar impaction syndrome include occasional swelling and pain with palpation over the ulnar side of the wrist. Depending on the underlying etiology, patients may demonstrate decreased wrist flexion-extension and/or pronation-supination.…”

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confidence: 99%

Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

2014

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Background Ulnar impaction syndrome is a condition in which the ulna impacts on the ulnar carpus. This most commonly occurs when the ulna is longer than the radius, but it can also occur in wrists with ulnar neutral and ulnar negative variance. Materials and Methods In this paper we outline our surgical technique for ulnar shortening osteotomy. A previously published retrospective case series of 28 patients treated at our center is presented. Fifty consecutive patients who underwent ulnar shortening osteotomy (USO) for ulnar impaction syndrome were approached for study, and 28 consented to review. Mean preoperative ulnar variance was þ2.3 mm, and mean postoperative ulnar variance was -0.8 mm. Mean follow-up time was 21.2 months (8 to 41 months) and ten of 28 were receiving workers' compensation. Mean preoperative pain score (visual analog scale; VAS) was 7.9. Univariate analysis was performed to assess clinical and demographic data. In addition, subgroup analysis of workers' compensation patients and smokers was performed. Description of Technique A longitudinal incision over the subcutaneous border of the ulna is used to expose the ulna between the distal and middle third of the ulna from the ulna styloid. Preoperative posteroanterior (PA) X-rays are reviewed to determine the amount of shortening required, with a goal of creating -2 mm variance postoperatively. A 6-hole dynamic compression plate is predrilled distally prior to performing two oblique osteotomies separated by the desired shortening length. The fragments are reduced, controlling for rotation, and plated using compression. In some cases, a lag screw is employed across the oblique osteotomy site. Results Mean pain scores were significantly reduced postoperatively (VAS 7.9 versus 3.1, P < 0.0001). The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 37.2 postoperatively. Flexion, extension, and supination were reduced compared with the contralateral unaffected extremity (84.6%, 85.3%, and 86.9% of normal). Patients receiving workers' compensation and smokers had significantly more pain postoperatively (VAS 5.2 vs. 2.0, P ¼ 0.0002 and VAS 4.4 vs 2.4, P < 0.05, respectively). Eleven of 28 patients required hardware removal for plate irritation, and five of 28 patients had a nonunion. Conclusion We present our surgical technique for ulnar shortening osteotomy. Pain was significantly improved in our population; however, patients receiving workers' compensation and smokers had less improvement in pain and higher disability scores.

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“…These patients' symptoms were refractory to conservative therapy. However, as discussed by McBeath et al, 22 symptomatic improvement following ulnar shortening osteotomy cannot be definitively attributed to the surgical intervention, as it may be the natural course of the illness, or the placebo effect. That is why a randomized, controlled trial with a larger patient population is needed to distinguish between surgical and nonsurgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna

El-Gammal

Rozée

2017

Jnl Wrist Surg

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The purpose of this study is to evaluate the results of patients with ulnar impaction syndrome treated with diaphyseal osteotomy using freehand technique and fixation with ulnar osteotomy compression plate placed on the ulnar surface of the ulna. A retrospective chart review of patients with ulnar impaction syndrome between 2010 and 2014 identified 38 patients. The following clinical data were observed: patient age, sex, range of motion, grip strength, visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological assessment, and complications. The mean follow-up period is 30 months. Eleven patients were excluded from the study. Compared with the contralateral side, the 27 patients included in this study attained 93 to 96% of wrist and forearm motion and 81% of the grip strength. The average DASH score was 18 in a mean follow-up period of 30 months. Three patients required plate removal and one case showed nonunion and a further operation was needed. Two patients reported persistent ulnar-sided wrist pain. We concluded that placing the ulnar osteotomy plate on the ulnar surface of the ulna is a quicker procedure, with less soft tissue dissection and irritation, and very high union rate. Level IV.

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Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

Cited by 22 publications

References 15 publications

Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate

Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate

Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna

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