A Dorsal Approach for Ulnar Shortening Osteotomy

Abstract

Aim This study aims to evaluate the long-term complications, results, and patient satisfaction rates of a dorsally approached ulnar shortening osteotomy for ulnar impaction syndrome.

Methods A retrospective chart review of 20 patients was performed. Primary outcomes of interest were subjective, measured using the Patient-Rated Wrist Evaluation (PRWE) score, Disability of the Arm, Shoulder, and Hand (DASH) score, and the third questionnaire about patient satisfaction, composed by the authors. Secondary outcomes included hardware removal due to irritation and other complications.

Results Mean postoperative functional score of PRWE was 28 (standard deviation [SD], 30) and DASH 20 (SD, 26), respectively. Fifteen patients were satisfied with the operation. Removal of hardware was noted in six patients. In one patient plate breakage occurred.

Conclusion Similar postoperative functional scores and complications were seen in patients undergoing an ulnar shortening osteotomy with a dorsally placed plate for ulnar impaction syndrome, compared with other plate placement localizations. The incidence of plate removal is also comparable to previously described results. As the dorsally placed plate and freehand technique, are relatively easy, we feel that it has a place in the treatment of ulnar impaction syndrome.

Level of Evidence Level IV, retrospective cohort study.

Keywords

ulnar shortening osteotomy - dorsal approach - hardware removal - ulnar impaction syndrome

Funding

None.

Note

The authors obtained approval of the medical ethical review committee.

• References

• 1 Nagy L, Jungwirth-Weinberger A, Campbell D, Pino JG. The AO ulnar shortening osteotomy system indications and surgical technique. J Wrist Surg 2014; 3 (02) 91-97
• 2 Fricker R, Pfeiffer KM, Troeger H. Ulnar shortening osteotomy in posttraumatic ulnar impaction syndrome. Arch Orthop Trauma Surg 1996; 115 (3-4): 158-161
• 3 Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2012; 37 (07) 1489-1500
• 4 Aminian A, Schoenecker PL. Premature closure of the distal radial physis after fracture of the distal radial metaphysis. J Pediatr Orthop 1995; 15 (04) 495-498
• 5 Iwasaki N, Ishikawa J, Kato H, Minami M, Minami A. Factors affecting results of ulnar shortening for ulnar impaction syndrome. Clin Orthop Relat Res 2007; 465 (465) 215-219
• 6 Das De S, Johnsen PH, Wolfe SW. Soft tissue complications of dorsal versus volar plating for ulnar shortening osteotomy. J Hand Surg Am 2015; 40 (05) 928-933
• 7 Stockton DJ, Pelletier ME, Pike JM. Operative treatment of ulnar impaction syndrome: a systematic review. J Hand Surg Eur Vol 2015; 40 (05) 470-476
• 8 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (01) 46-53
• 9 Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand: which one to choose?. Int Orthop 2008; 32 (01) 1-6
• 10 Brink SM, Voskamp EG, Houpt P, Emmelot CH. Psychometric properties of the Patient Rated Wrist/Hand Evaluation-Dutch Language Version (PRWH/E-DLV). J Hand Surg Eur Vol 2009; 34 (04) 556-557
• 11 Schuurman AH, Sleegers E. The quick DASH outcome measure DLV (2003). Available at: http://www.dash.iwh.on.ca/sites/dash/public/translations/QuickDASH_Dutch.pdf . Accessed September 29, 2014
• 12 Wehbé MA, Cautilli DA. Ulnar shortening using the AO small distractor. J Hand Surg Am 1995; 20 (06) 959-964
• 13 Milch H. Cuff resection of the ulna for malunited Colles' fracture. J Bone Joint Surg 1941; 39: 311-313
• 14 Doherty C, Gan BS, Grewal R. Ulnar shortening osteotomy for ulnar impaction syndrome. J Wrist Surg 2014; 3 (02) 85-90
• 15 Fufa DT, Carlson MG, Calfee RP, Sriram N, Gelberman RH, Weiland AJ. Mid-term results following ulna shortening osteotomy. HSS J 2014; 10 (01) 13-17
• 16 Srinivasan RC, Jain D, Richard MJ, Leversedge FJ, Mithani SK, Ruch DS. Isolated ulnar shortening osteotomy for the treatment of extra-articular distal radius malunion. J Hand Surg Am 2013; 38 (06) 1106-1110
• 17 Ahsan ZS, Song Y, Yao J. Outcomes of ulnar shortening osteotomy fixed with a dynamic compression system. J Hand Surg Am 2013; 38 (08) 1520-1523
• 18 Luria S, Lauder AJ, Trumble TE. Comparison of ulnar-shortening osteotomy with a new Trimed dynamic compression system versus the Synthes dynamic compression system: clinical study. J Hand Surg Am 2008; 33 (09) 1493-1497
• 19 Fulton C, Grewal R, Faber KJ, Roth J, Gan BS. Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome. Can J Plast Surg 2012; 20 (01) e1-e5
• 20 Lautenbach M, Millrose M, Schmidt NS, Zach A, Eichenauer F, Eisenschenk A. Ulnocarpal impaction syndrome: treatment with a transverse ulnar shortening osteotomy from an ulnodorsal approach. Arch Orthop Trauma Surg 2014; 134 (06) 881-885
• 21 Loh YC, Van Den Abbeele K, Stanley JK, Trail IA. The results of ulnar shortening for ulnar impaction syndrome. J Hand Surg [Br] 1999; 24 (03) 316-320
• 22 Köppel M, Hargreaves IC, Herbert TJ. Ulnar shortening osteotomy for ulnar carpal instability and ulnar carpal impaction. J Hand Surg Am 1997; 22B [phone]
• 23 Huang HK, Wang JP, Wang ST, Huang YC, Liu CL. Freehand technique with the predrilled hole method for ulnar-shortening osteotomy. J Chin Med Assoc 2016; 79 (02) 77-82
• 24 Isaacs J, Howard SB, Gulkin D. A prospective study on the initial results of a low profile ulna shortening osteotomy system. Hand (NY) 2010; 5 (02) 148-154
• 25 Kitzinger HB, Karle B, Löw S, Krimmer H. Ulnar shortening osteotomy with a premounted sliding-hole plate. Ann Plast Surg 2007; 58 (06) 636-639
• 26 Tatebe M, Shinohara T, Okui N, Yamamoto M, Hirata H, Imaeda T. Clinical, radiographic, and arthroscopic outcomes after ulnar shortening osteotomy: a long-term follow-up study. J Hand Surg Am 2012; 37 (12) 2468-2474
• 27 Kim JK, Park ES. Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res 2013; 471 (05) 1406-1411
• 28 Moermans A, Degreef I, De Smet L. Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (06) 310-314
• 29 Rajgopal R, Roth J, King G, Faber K, Grewal R. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (NY) 2015; 10 (03) 535-540
• 30 Rayhack JM, Gasser SI, Latta LL, Ouellette EA, Milne EL. Precision oblique osteotomy for shortening of the ulna. J Hand Surg Am 1993; 18 (05) 908-918
• 31 Clark SM, Geissler WB. Results of ulnar shortening osteotomy with a new plate compression system. Hand (NY) 2012; 7 (03) 281-285
• 32 Chen NC, Wolfe SW. Ulna shortening osteotomy using a compression device. J Hand Surg Am 2003; 28 (01) 88-93
• 33 Renfree KJ, Odgers RA. Stacked-blade, single-cut, ulnar-shortening osteotomy. Orthopedics 2015; 38 (02) e80-e87
• 34 Tränkle M, van Schoonhoven J, Krimmer H, Lanz U. Indication and results of ulna shortening osteotomy in ulnocarpal wrist joint pain [in German]. Unfallchirurg 2000; 103 (03) 197-202
• 35 Pouliot M, Yao J. Ulnar shortening osteotomy utilizing a TriMed ulnar osteotomy system. Tech Hand Up Extrem Surg 2014; 18 (02) 72-76
• 36 Schmidle G, Arora R, Gabl M. Ulnar shortening with the ulna osteotomy locking plate. Oper Orthop Traumatol 2012; 24 (03) 284-292
• 37 Hamada Y, Sairyo K, Hibino N, Kobayashi A, Sato R. Effect of preservation of corticoperiosteal attachment on bone healing at osteotomy sites after ulna-shortening osteotomy. Hand (NY) 2015; 10 (01) 105-110
• 38 Nagle DJ, Bernstein MA. Laser-assisted arthroscopic ulnar shortening. Arthroscopy 2002; 18 (09) 1046-1051