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Ulnar-shortening osteotomy effective for treatment of ulnar impaction syndrome
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Researchers found performing ulnar-shortening osteotomy with a single oblique cut and stacked saw blades was a cost-effective and clinically useful method for treating ulnar impaction syndrome, with the potential for use with other bones needing shortening-osteotomies.
During a 10-year study, the researchers retrospectively reviewed the medical records of patients who underwent ulnar-shortening osteotomies (USOs) using a single oblique cut with two or three stacked saw blades. Twenty-three wrists of 21 patients (mean age: 45 years) with chronic ulnar impaction syndrome and an average ulnar variance of +2.1 mm were studied. Average postoperative follow-up was 23 months.
Prior to surgery, patients had an average wrist flexion of 64°, an average extension of 65°, an average supination of 70° and an average pronation of 78. Additionally, grip strength was 25 kg in the involved extremity and 32 kg in the uninvolved extremity.
Oblique osteotomy was performed in the distal one-third of the ulnar diaphysis at an estimated angle of 45° or 60° relative to the ulnar axis. The osteotomy was then fixed with a seven-hole, 2.7-mm or 3.5-mm dorsally placed dynamic compression plate.
The average amount of postoperative ulnar shortening, as determined by the change in measured variance between pre- and postoperative radiographs, was 2.8 mm. The average final ulnar was −0.6 mm.
Postoperative grip strength was, on average, 27 kg. With regard to postoperative active range of motion, average flexion was 60°, average supination was 76°, average extension was 65° and average pronation was 78°. Additionally, the researchers noted complete bony union in all 23 osteotomies.
Ten patients had the hardware removed due to pain, and two others complained of pain but declined having the hardware removed. According to the researchers, 22 wrists achieved ulnar-sided wrist pain relief. – by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
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