Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

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 +2.3 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 = 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.

[1]  J. D. del Pino Ulnar shortening osteotomy. , 2014, Journal of wrist surgery.

[2]  E. Shin,et al.  Ulnar shortening osteotomy for ulnar impaction syndrome. , 2013, The Journal of hand surgery.

[3]  K. Faber,et al.  Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome. , 2012, The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique.

[4]  G. Baek,et al.  Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up , 2011, Clinics in orthopedic surgery.

[5]  M. Rizzo,et al.  Ulnar impaction. , 2010, Hand clinics.

[6]  T. Gillon,et al.  Osteochondral Shortening Osteotomy for the Treatment of Ulnar Impaction Syndrome: A New Technique , 2007, Techniques in hand & upper extremity surgery.

[7]  L. de Smet,et al.  Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome , 2007, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[8]  G. Baek,et al.  Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. , 2005, The Journal of bone and joint surgery. American volume.

[9]  K. Firoozbakhsh,et al.  Dynamic effects of joint-leveling procedure on pressure at the distal radioulnar joint. , 2005, The Journal of hand surgery.

[10]  E. Horii,et al.  Results of Ulnar Shortening Osteotomy for Ulnocarpal Impaction Syndrome in Wrists with Neutral or Negative Ulnar Variance , 2005, Journal of hand surgery.

[11]  M. Bernstein,et al.  A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  K. Pfeiffer,et al.  Mar shortening osteotomy in posttraumatic ulnar impaction syndrome , 2004, Archives of Orthopaedic and Trauma Surgery.

[13]  Francisco del Piñal,et al.  Imaging findings in ulnar-sided wrist impaction syndromes. , 2002, Radiographics : a review publication of the Radiological Society of North America, Inc.

[14]  M. Tomaino The importance of the pronated grip x-ray view in evaluating ulnar variance. , 2000, The Journal of hand surgery.

[15]  J. Stanley,et al.  The Results of Ulnar Shortening for Ulnar Impaction Syndrome , 1999, Journal of hand surgery.

[16]  A. Minami,et al.  Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. , 1998, The Journal of hand surgery.

[17]  T. Imaeda,et al.  The Ulnocarpal Stress Test in the Diagnosis of Ulnar-Sided Wrist Pain , 1997, Journal of hand surgery.

[18]  T. Herbert,et al.  Ulnar Shortening Osteotomy for Ulnar Carpal Instability and Ulnar Carpal Impaction , 1997 .

[19]  A. Palmer,et al.  The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. , 1993, The Journal of hand surgery.

[20]  J. Stanley,et al.  The Gymnast’s Wrist: Acquired Positive Ulnar Variance Following Chronic Epiphyseal Injury , 1992, Journal of hand surgery.

[21]  P. Feldon,et al.  Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. , 1992, The Journal of hand surgery.

[22]  D. C. Wnorowski,et al.  Anatomic and biomechanical analysis of the arthroscopic wafer procedure. , 1992, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[23]  J. Dobyns,et al.  Gymnast's wrist. , 1990, Hand clinics.

[24]  A. Palmer,et al.  Biomechanics of the distal radioulnar joint. , 1984, Clinical orthopaedics and related research.

[25]  H. Milch Cuff resection of the ulna for malunited Colles' fracture. , 1941 .