Abstract
BackgroundUlnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch.MethodsWe retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients.ResultsWe enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36–179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o–23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o–11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0–1; SD, 0.4) at rest and 1.3 (range, 0–3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3–34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70–100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.ConclusionsFor patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.
Highlights
Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome
For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the distal radioulnar joint (DRUJ)
The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO
Summary
Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. There have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch. Ulnar shortening osteotomy (USO) is a commonly performed procedure that can treat many ulnar-sided wrist problems, including ulnar impaction syndrome, triangular fibrocartilage complex (TFCC) problems, instability of the distal radioulnar joint (DRUJ), and lunotriquetral ligament tear [1,2,3,4,5]. There is a concern that if USO is carried out on a wrist with a type 3 reverse oblique pattern sigmoid notch, it could increase the contact pressure at the proximal aspect of the inverted sigmoid notch. It is suspected that accelerated degenerative changes occur due to the contact of unmatched joint surfaces [10, 11]
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