Ulnar Shortening Osteotomy in Idiopathic Ulnar Impaction Syndrome

Baek, Goo Hyun; Chung, Moon Sang; LEE, YOUNG HO; Gong, Hyun Sik; Lee, S.; KIM, HYUNG HO

doi:10.2106/00004623-200512000-00008

Cited by 39 publications

(33 citation statements)

References 15 publications

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“…35 Other advantages of ulnar shortening osteotomy are the maintenance of the cartilage surface at the distal ulna and the simplicity of the procedure without bone grafting. 20,[36][37][38] The disadvantages of ulnar shortening are nonunion/delayed union and hardware irritation. 6,10,15,[17][18][19] However, rates of complication can be low if the procedure is properly performed, 5,38 and many papers have actually reported low complication rates.…”

Section: Discussionmentioning

confidence: 99%

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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The ulnar side of the wrist has been referred to as the "black box" of the wrist, and pathologies of this region have been compared with those of low back pain, 1,2 given the complex anatomy, myriad differential diagnosis, and varied treatment outcomes. Ulnar-sided wrist pain and arise from an acute traumatic injury or a chronic degenerative condition. Common causes of ulnar-sided wrist pain include isolated injuries to the triangular fibrocartilage complex (TFCC) or lunotriquetral ligament as well as ulnar impaction syndrome, which consists of a combination of these 2 conditions along with an Keywords ► ulnar shortening osteotomy ► ulnar-sided wrist pain ► TFCC ► DRUJ ► arthroscopy AbstractBackground The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV

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Section: Discussionmentioning

confidence: 99%

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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“…The surgical procedures were performed as previously described [2,19] with a six-hole low-contact dynamic compression plate (Synthes, Paoli, PA, USA) or seven-hole recon plate (Synthes) using transverse osteotomy. Postoperatively, patients were treated with a short arm splint for the first 4 weeks.…”

Section: Methodsmentioning

confidence: 99%

“…Importantly, questionnaires can detect clinical changes in patients; however, this impact has not been determined for ulnar impaction syndrome. Questions/purposes We asked (1) which of Patient-Rated Wrist Evaluation (PRWE), DASH, and other physical measures was more responsive to clinical improvements, and (2) what was the minimal clinically important difference for the PRWE and DASH after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. Methods All patients who underwent ulnar shortening osteotomy between March 2008 and February 2011 for idiopathic ulnar impaction syndrome were enrolled in this study.…”

Section: Introductionmentioning

confidence: 99%

“…Idiopathic ulnar impaction syndrome is a degenerative condition characterized by ulnar-sided wrist pain and swelling related to load-bearing across the ulnar aspect of the wrist without a history of fracture or premature physeal arrest of the distal part of the radius [2]. Several studies have shown that ulnar shortening osteotomy generally has succeeded at decreasing pain and increasing functional ability in idiopathic ulnar impaction syndrome [2,5,6,19,22,25,29], but clinician-rated outcome measurements (instead of patient-reported questionnaires) have been used in the majority of these studies.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Responsiveness and Minimal Clinically Important Differences for Idiopathic Ulnar Impaction Syndrome

Kim

Park

2013

Clinical Orthopaedics &Amp; Related Research

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Background Patient-reported questionnaires have been widely used to predict symptom severity and functional disability in musculoskeletal disease. Importantly, questionnaires can detect clinical changes in patients; however, this impact has not been determined for ulnar impaction syndrome. Questions/purposes We asked (1) which of Patient-Rated Wrist Evaluation (PRWE), DASH, and other physical measures was more responsive to clinical improvements, and (2) what was the minimal clinically important difference for the PRWE and DASH after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. Methods All patients who underwent ulnar shortening osteotomy between March 2008 and February 2011 for idiopathic ulnar impaction syndrome were enrolled in this study. All patients completed the PRWE and DASH questionnaires, and all were evaluated for grip strength and wrist ROM, preoperatively and 12 months postoperatively. We compared the effect sizes observed by each of these instruments. Effect size is calculated by dividing the mean change in a score of each instrument during a specified interval by the standard deviation of the baseline score. In addition, patient-perceived overall improvement was used as the anchor to determine the minimal clinically important differences on the PRWE and DASH 12 months after surgery. Results The average score of each item except for wrist flexion and supination improved after surgery. The PRWE was more sensitive than the DASH or than physical measurements in detecting clinical changes. The effect sizes and standardized response means of the outcome measures were as follows: PRWE (1.51, 1.64), DASH (1.12, 1.24), grip strength (0.59, 0.68), wrist pronation (0.33, 0.41), and wrist extension (0.28, 0.36). Patient-perceived overall improvement and score changes of the PRWE and DASH correlated significantly. Minimal clinically important differences were 17 points (of a possible 100) for the PRWE and 13.5 for the DASH (also of 100), and minimal detectable changes were 7.7 points for the PRWE and 9.3 points for the DASH. Conclusions Although the PRWE and DASH were highly sensitive to clinical changes, the PRWE was more sensitive in terms of detecting clinical changes after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. A minimal change of 17 PRWE points or 13.5 DASH points was necessary to achieve a benefit that patients perceived as clinically important. The minimal clinically important differences using these instruments were higher than the values produced by measurement errors.

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“…Early outcomes following ulna shortening osteotomy for the treatment of ulnar impaction syndrome have demonstrated good pain relief, satisfactory objective outcomes (motion, strength, and healing), and patient satisfaction [1,4,6,12,16]. The most commonly reported complications of ulnar shortening osteotomy are plate irritation (8-56%) and ulnar nonunion (approximately 5%) [2,15,18].…”

Section: Introductionmentioning

confidence: 99%

Mid-Term Results following Ulna Shortening Osteotomy

Fufa

Carlson

Calfee

et al. 2014

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Successful short-term results of diaphyseal ulna shortening osteotomy are documented in both idiopathic and post-traumatic ulnar impaction. Questions/Purposes: The purpose of this study was to evaluate the mid-term outcomes of ulnar shortening osteotomy with respect to radiographic assessment of corrected alignment and healing as well as patient satisfaction, pain, and function assessed using the Disability of the Arm, Shoulder, and Hand (DASH) score. Patients and Methods: This retrospective case series included follow-up of 33 patients with ulnar impaction syndrome following ulna shortening osteotomy at a minimum of 5 years. Patient-rated outcomes included satisfaction, pain assessment, and DASH score. Pre-and postoperative radiographs were reviewed to quantify ulnar variance and osteotomy union rates. Subsequent operations were also recorded. Results: Average followup was 10 years (range, 5-20 years). Eighty-eight percent of patients reported they were either satisfied or very satisfied with the procedure and 91% reported they would have the same procedure again. Average pain rating was 2 out of 10 at final follow-up. The mean DASH score was 11 (range, 0-39). Removal of hardware was performed in 10 patients (30%). The overall rate of reoperation was 45%. Conclusions: Ulna shortening osteotomy yields reliable midterm satisfaction and pain relief in patients with idiopathic and post-traumatic ulnar impaction syndrome. Reoperation is frequent. Consistent with results of short-term follow-up, plate irritation requiring removal remains the most common cause for reoperation over time.

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Ulnar Shortening Osteotomy in Idiopathic Ulnar Impaction Syndrome

Cited by 39 publications

References 15 publications

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Comparative Responsiveness and Minimal Clinically Important Differences for Idiopathic Ulnar Impaction Syndrome

Mid-Term Results following Ulna Shortening Osteotomy

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