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Study finds step-cut ulnar shortening osteotomy effective for treatment of ulnar impaction syndrome
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Results from this study demonstrated the safety and reliability of step-cut ulnar shortening osteotomy, which provided quick recovery and early return to activities in patients treated for ulnar impaction syndrome.
Researchers performed a retrospective study of 164 patients who underwent step-cut ulnar osteotomy for ulnar impaction syndrome. Investigators collected subjective patient evaluations and objective evaluations preoperatively and postoperatively. The VAS was used to assess pain, and a goniometer was used to assess the wrist range of motion. Investigators also assessed grip strength and wrist function. The amount of ulnar shortening was determined with a comparison of preoperative and postoperative grip-view radiographs. Patients had a minimum follow-up of 2 years.
Results showed at a mean of 8.2 weeks, patients achieved union. The overall union rate of the group was 98.8%. Investigators noted two patients needed additional surgery due to nonunion. Investigators found +0.2 mm in mean ulnar variance postoperatively and the mean overall ulnar shortening was 2.5 mm.
According to researchers, at a mean of 4 months, all patients were able to return to previous work. Twelve patients needed the plate removed due to plate-related symptoms, and no other complications were seen. ‒ by Monica Jaramillo
Disclosures: Papatheodorou reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Kevin J. Renfree, MD
This retrospective review of a large patient group from a busy, academic hand surgery practice highlights excellent clinical results with the use of a step-cut ulnar shortening osteotomy for symptomatic idiopathic or post-traumatic ulnar abutment. It is a simple and inexpensive technique, which may produce better rotational alignment than a transverse or oblique osteotomy.
Researchers demonstrated a high union rate (99%) and significant improvement in pain scores, range of motion and Mayo modified wrist scores, regardless of whether negative ulnar variance was achieved postoperatively. The amount of shortening was limited to a mean of 2.5 mm, which may be the key reason for a low incidence of asymptomatic radiographic post-traumatic arthritis at the distal radio-ulnar joint (5.5%). Although the mean follow-up of 24 months is acceptable, researchers admitted that more arthritic changes or symptoms could develop with time.
The procedure is safe, with a low complication rate of 1.2% nonunion and a 7.3% incidence of plate removal. Researchers attributed the low incidence of hardware removal (compared to previously published reports) to the use of a low-profile plate placed volarly. Researchers emphasized the need to use a lag screw across the vertical osteotomy.
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