Ulnar Shortening Osteotomy Research Articles

Background:Ulnar wrist complaints are common but difficult to diagnose due to the complex anatomy of the wrist. Ulnar impaction syndrome (UIS) is associated with positive ulnar variance but can also occur with neutral or negative variance. Other causes include an elongated ulnar styloid and a type II lunate. This study sought to determine the prevalence of these conditions and their relation with UIS in a large population.Methods:Approximately 7000 wrist radiographs were evaluated for neutrality, of which 1780 were included. Trained observers measured ulnar variance and ulnar styloid length, and calculated the ulnar styloid process index (USPI) and styloid–capitate ratio (SCR). The lunate type was also classified.Results:Average ulnar variance was found to be 0.19 mm, with a mean ulnar styloid length of 5.45 mm. The USPI averaged 0.27, and the SCR was 0.23. Depending on the thresholds (1 and 2 mm), 11%–30% exhibited positive ulnar variance. Seven percent of patients underwent ulnar shortening osteotomy. An elongated ulnar styloid was observed in 32% of wrists, with only 1 case of UIS due to an elongated ulnar styloid. Type II lunate was more prevalent than type I (56% versus 44%), with possible left–right discrepancies.Conclusions:Ulnar plus variance is common but infrequently causes symptoms, even in cases with neutral or negative ulnar variance, highlighting its dynamic nature. The USPI is the best measure for impaction risk, whereas SCR refines styloid assessment. Lunate type did not influence the decision for surgery, emphasizing the need for dynamic, multifactorial wrist evaluation for accurate diagnosis and management.

Background: Diaphyseal ulna shortening osteotomy (USO) is an accepted treatment for multiple ulnar sided wrist pathologies. Recently, a number of specifically designed compression plates for USO have become available. The purpose of the study was to assess the outcomes of an ulnar osteotomy compression plate system for USO across multiple centres. Methods: A multicentre cohort study was conducted on USO performed for a variety of ulnar-sided wrist pathologies using a USO compression system. Radiographic, clinical and subjective outcomes were assessed postoperatively and compared between aetiologies. Results: A total of 174 USOs were performed with union achieved in 170 osteotomies. Overall satisfaction was high and 83.2% returned to work. And 31.6% of patients required plate removal. Conclusions: The use of a specific USO compression plate provides a reasonable option for USO with similar results across multiple sites. High union rates can be achieved. However, the incidence of plate removal was high and remains a potential concern warranting further study. Level of Evidence: Level IV (Therapeutic).

Effect of mental practice on surgical trainees' ability to describe an ulnar shortening osteotomy after video observation: An experimental study.

Abstract Ulnar shortening osteotomy (USO) is a common surgical procedure for ulnar impaction syndrome. However, some hospitals lack specialized USO plates, or patients decline them due to high costs. The freehand technique for USO lacks precision; therefore, we utilized 3D-printed guide plates to assist in performing USO and fixation with standard ulnar locking plates.A retrospective case series of 87 patients was conducted using 3D-printed guide plates to achieve precise USO and fixation with standard ulnar locking plates. Primary outcomes included the patient-rated wrist evaluation (PRWE), disabilities of the arm, shoulder, and hand (DASH) questionnaire, and a custom patient satisfaction survey. Secondary outcomes included implant removal due to irritation and other complications.The mean postoperative functional scores were 26 (standard deviation [SD]: 30) for PRWE and 21 (SD: 26) for DASH. Seventy-five patients reported satisfaction with the procedure. Thirty-six patients underwent implant removal due to irritation, with no plate fractures observed. One patient experienced nonunion, which healed after bone grafting, yielding a union rate of 98.9%.This technique offers precise shortening and improved osteotomy angulation accuracy while increasing the contact area at the osteotomy site—theoretically reducing the nonunion rate. It is particularly suitable for hospitals without access to specialized USO plates.

The purpose of this study is to evaluate the rotational stability of 1-screw versus 2-screw antegrade fixation in distal metaphyseal ulnar shortening osteotomies (DMUSOs) using matched cadaveric forearm specimens. In addition, we aim to assess the mode of failure for each construct, specifically determining whether failure occurs due to hardware failure or peri-implant fractures. Sixteen fresh-frozen cadaveric forearm specimens, organized into 8 matched pairs, were used. Ulnas were harvested, transected at the midshaft, and all soft tissue attachments were removed. A 5-mm oblique shortening osteotomy was created in the distal metaphysis, proximal to the ulnar head. Fixation was performed using either a single Acutrak 2 Mini 3.5 mm screw or 2 Acutrak 2 Micro 2.5 mm screws. Under a constant 10 N axial compressive load, specimens were cyclically loaded at 5°/second, beginning at 0.25 N m, and increasing by 0.25 N m every 500 cycles. Testing continued until failure, defined as either 10° of rotational displacement or catastrophic structural failure. The 2-screw construct exhibited significantly greater torque resistance compared with 1-screw fixation (0.84 N m [95% confidence interval, CI: 0.61-1.08] vs 0.63 N m [95% CI: 0.52-0.73], P = .016). In all instances, failure occurred due to rotational displacement exceeding 10°. In a matched cadaveric study examining DMUSO constructs, 2 smaller headless compression screws provided greater rotational stability than a single larger headless compression screw. The antegrade 2-screw fixation may allow for improved rotational stability across the DMUSO, allowing short-arm immobilization postoperatively, with earlier wrist pronosupination.

Abstract Report on surgical management of ulnar impaction syndrome secondary to chronic Monteggia fractures are limited, and optimal techniques and outcomes remain unclear. Herein, we report a case in which preoperative stress evaluation followed by diaphyseal-level ulnar-shortening osteotomy led to favorable clinical outcomes.A 54-year-old woman with a childhood forearm injury presented with ulnar-sided wrist pain. Imaging revealed ulnar impaction syndrome with foveal triangular fibrocartilage complex (TFCC) injury. An asymptomatic anterior radial head dislocation, consistent with a chronic Monteggia fracture, was also identified. Conservative management was unsuccessful; thus, she underwent diaphyseal-level ulnar-shortening osteotomy and TFCC reconstruction. The dislocated radial head remained stable under longitudinal stress, justifying the ostomy alone without radial head intervention. Postoperatively, distal radioulnar joint instability resolved immediately. At 18 months, the radial head had not migrated proximally, and the patient was pain-free.Ulnar-shortening osteotomy for ulnar impaction syndrome secondary to chronic Monteggia fracture raises concerns about proximal radial head migration through the interosseous membrane. However, our findings indicate that when the dislocated radial head remains stable under longitudinal stress, diaphyseal ulnar-shortening osteotomy may be an effective treatment option.

Background: Managing ulnar wrist pain without ulnar plus variance presents a clinical challenge. This study aimed to compare the causes of symptom onset and surgical outcomes between arthroscopic triangular fibrocartilage complex (TFCC) repair and ulnar shortening osteotomy (USO) and analyse factors influencing pain reduction following arthroscopic TFCC repair. Methods: Twenty-four patients without ulnar plus variance who underwent either arthroscopic TFCC repair or USO at our institution were retrospectively reviewed. Demographic data, symptom onset causes, time from onset to surgery, pre- and postoperative range of motion (ROM), grip strength ratio (injured to uninjured wrist), numeric pain rating scale (NRS), change in NRS and Hand20 scores were compared between the two treatment groups. For TFCC repair, correlations were investigated between NRS change and time from onset to surgery and between NRS change and age. Results: Of 24 patients, 14 underwent arthroscopic TFCC repair and 10 underwent USO. Only two patients in the USO group had no clear onset trigger, whereas most had identifiable triggers. Both groups showed no significant differences in pre- and postoperative ROM, grip strength ratio, NRS and Hand20 score. The change in NRS was significantly greater in the USO group (p = 0.049). For the TFCC repair group, NRS change was significantly negatively correlated with age (Spearman's rank correlation coefficient -0.603, p = 0.029). Conclusions: Our findings indicate that patients without ulnar plus variance who experience symptom onset including trauma often have an underlying degenerative component as well as instability. USO provides significant pain relief in such cases. Arthroscopic TFCC repair was effective in young patients in whom instability was the primary cause of pain and age was associated with pain reduction rather than time from onset to surgery. Effective treatment strategies for ulnar wrist pain without ulnar plus variance should consider both age and wrist arthroscopy findings to optimise outcomes. Level of Evidence: Level IV (Therapeutic).

Introduction: While arthroscopic TFCC debridement (TFCC-D) has proven successful for the treatment of pathological tears, a subset of patients may present with persistent or recurrent ulnar-sided wrist pain and require revision debridement, repair, and/or ulnar shortening osteotomy (USO). We present a retrospective comparative study that evaluates the clinical outcomes of 83 patients who underwent TFCC-D (N=17) or TFCC-D+USO (N=66). Materials and Methods: Preoperative ulnar variance was measured on standard posteroanterior (PA) view and gripping PA view radiographs. Clinical outcomes at final follow up included visual analog scale (VAS) pain scores, grip and pinch strength recovery, active wrist range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient Rated Wrist Evaluation (PRWE) questionnaires. Results: We report on 83 cases, mean age 45 years (range, 18–74 years), who underwent surgery between September 2016 and March 2020. Mean follow-up time was 93 weeks (range, 49–237 weeks). Mean VAS scores decreased from 7.4 to 5.3 in the TFCC-D group and from 6.7 to 2.9 in the TFCC-D+USO group. Patients in the TFCC-D group reported significantly higher QuickDASH (44.6 vs. 17.0) and PRWE scores (76.8 vs. 30.7) compared to the TFCC-D+USO group. Nine TFCC-D cases were indicated for revision compared with one TFCC-D+USO case. Eight of the nine TFCC-D cases indicated for revision exhibited positive ulnar variance on gripping PA view. Conclusions: Patients treated with TFCC-D+USO reported superior outcomes to those treated with TFCC-D alone on the basis of pain scores, QuickDASH and PRWE scores, and need for revision surgery.

Combined radial closing-wedge osteotomy and ulnar shortening osteotomy for distal radius malunion.

Ulnar Shortening With Rotational Osteotomy of the Distal Facing Sigmoid Notch for Ulnar Carpal Abutment Syndrome.

Changes in Distal Radioulnar Joint Stability With Metaphyseal Versus Diaphyseal Ulnar Shortening Osteotomies: A Biomechanical Investigation.

Background and purposeWe primarily aimed to report the results of ulnar shortening osteotomy (USO) in cases of ulna impaction syndrome (UIS), and secondarily to assess the influence of etiology, radiographic parameters, and comorbidities on the outcome.MethodsPatients with USO performed for UIS between 2014 and 2022 at our department were included in the study. Demographic, surgical, and postoperative data, including complications and revisions, were recorded retrospectively. An additional study-specific follow-up was performed in all available cases, including subjective outcome measures as Patient Related Wrist Evaluation (PRWE) and Quick Disability of the Arm Shoulder and Hand (Quick-DASH) scores, and standardized 90–90° wrist radiographs.Results47 patients were treated with USO at mean age 45.8 years (standard deviation [SD] 16.7); 28 were female; median follow-up was 37 months (interquartile range [IQR] 22–57). Isolated USO was performed in 27 cases; the rest received a combination of procedures, e.g., wrist arthroscopy. USO-specific devices were used in all cases. Reoperations were performed in 12 cases, with implant removal in 11. Postoperative complications such as chronic regional pain syndrome or pseudoarthrosis were detected in 9 patients. 29 patients were additionally examined at median 36 months (IQR 22–49) follow-up. A median PRWE score of 7 (IQR 0–19) and a median Quick-DASH score of 4.5 (IQR 0–15.9) were reported. The subjective improvement was rated as very high by 24 patients. Radiographs showed a mean ulnar shortening of 2.9 mm (SD 1.1) and bone consolidation was achieved in all osteotomies at last follow-up. Relevant comorbidities weakly correlated with worse outcome scores (ρ = 0.41, 95% confidence interval [CI] –0.05 to 0.74 for PRWE and ρ = 0.40, CI –0.06 to 0.73 for Quick-DASH). No statistically significant difference could be detected in any other variables, including UIS etiology.ConclusionWe found that USO had good subjective results measure scores, but with relatively high complication and revision rates, including implant removal.

Diagnostic wrist arthroscopy is considered the gold standard for evaluating wrist joint complaints. Although this tool is often used to diagnose and stage scapholunate ligament (SLL) lesions, reports about the possible findings and their clinical relevance are scarce. Therefore, this study describes the patient characteristics, arthroscopic findings, and treatment of patients who underwent diagnostic arthroscopy for suspected SLL injury. We conducted a retrospective cohort study of patients who underwent diagnostic wrist arthroscopy due to suspicion of a SLL lesion based on medical history, physical examination, and imaging. We systematically gathered arthroscopic findings and complications. This study included 324 patients, predominantly male (55%), with a median age of 44 years (IQR 29 to 54) and symptom duration of ten months (IQR 5 to 24). The indication of SLL injury was arthroscopically confirmed in 253 patients (78%). Isolated SLL injuries were found in 92 patients (28%) (Geissler I/II: 32%; III: 37%; IV: 32%). SLL lesions and SLL-associated cartilage damage were discovered in 31 patients (10%). Additional findings were found in 181 patients (56%), such as triangular fibrocartilage complex lesions (36%), lunotriquetral ligament lesions (7%), and radioscaphocapitate ligament lesions (11%). No pathology was found in 20 patients (6%). In 27 patients (8%), complications occurred due to wrist arthroscopy. The most common follow-up surgeries were 3LT (40%), salvage procedures (9%), and ulnar shortening osteotomy (6%). While diagnostic wrist arthroscopy commonly confirms the suspected SLL lesions and their severity, it often reveals additional pathologies (un)related to the suspected pathology. It is essential to perform the procedure thoroughly to establish all possible pathologies. Determining the appropriate treatment for these additional findings is not always straightforward and needs further investigation.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement.Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively.Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved.Conclusion: Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Abstract Objectives This study aims to compare nonunion rates between conventional plates versus specific systems for ulnar shortening osteotomy (USO). Materials and Methods To identify relevant studies, we searched various databases, including MEDLINE via Ovid, Embase.com, Web of Science Core Collection, Cochrane CENTRAL via Wiley, and Google Scholar. The level of evidence was assessed independently by three evaluators. Preferred reporting items for systematic reviews (PRISMA) recommendations were followed during the study selection process, which involved applying inclusion and exclusion criteria. All studies that reported the postoperative nonunion rates and mentioned the manufacturer of the fixation device were included. A total of 42 studies were analyzed, with information retrieved on osteotomy type, fixation type, manufacturer, bone union period, and nonunion rate for each study. Results A total of 42 relevant articles were included in this study, with a total sample size of 1617 cases. The nonunion rate with the conventional plates was 5% (41 nonunion out of 815 cases).The reported nonunion rate was 0% (0 out of 67 cases) for the Stryker Trauma plates, 1.9% (three nonunion out of 157 cases) for the Rayhack plates, 4% (11 nonunion out of 271 cases) for the Acumed plates, 10.3% (3 nonunion out of 29 cases) for the specialized AO plates and 5% (14 nonunion and out of 278 cases) for the TriMed plates. Conclusion Despite advances in plate designs for USO, the overall nonunion rate with USO-specific systems is almost comparable to that of conventional plates. So, it seems likely that the surgical technique and patient characteristics may play a more significant role than the type of device when planning for a USO. Cost and time savings should be weighed and considered when choosing between the less expensive conventional plates versus USO-specific systems. Level of Evidence Prognostic level IV

Lunotriquetral ligament injuries are infrequent and less well understood than the more commonly injured scapholunate ligament and represent a continuum of injuries from degenerative tears to total dissociation. Diagnosis can be elusive because only severe injuries with associated extrinsic ligament injury result in visible radiographic changes. The entire spectrum of injury can cause disabling pain and wrist dysfunction. An understanding of carpal anatomy and biomechanics is necessary for adequate care of these patients. History and physical examination are the cornerstones for diagnosis. Various patient factors, such as injury severity, degree of instability, and physical demands, determine treatment options. Options included steroid injections with immobilization, arthroscopic débridement, ligament repair, ligament reconstruction, intercarpal arthrodesis, and ulnar shortening osteotomy. Diagnostic and surgical techniques have slowly improved outcomes of this condition over the past two decades.

Neglected distal radial epiphyseal injuries can result in radial deformity and positive ulnar variance. We describe an inverted-dome radial osteotomy and ulnar shortening osteotomy to treat a paediatric distal radial malunion with ulnar impaction syndrome.Level of evidence: V.

Decompression corrective osteotomy of the distal radius for treatment of the DRUJ-incongruency and impingement syndrome with focus on posttraumatic cases

The aim of this retrospective study was to evaluate the long-term outcome of ulnar shortening osteotomy. A total of 66 patients treated with an ulnar shortening osteotomy for a primary or post-traumatic ulnar impaction syndrome were included, with a median follow-up time of 75 months.There was a positive correlation between the sigmoid notch angle and the final QuickDASH score, but no correlation with final range of motion, grip strength or pain level. Radiological signs of osteoarthritis of the distal radioulnar joint were seen in 20% of patients, yet there was no correlation between the development of distal radioulnar joint osteoarthritis and the sigmoid notch angle. No symptomatic distal radioulnar joint osteoarthritis was observed.Ulnar shortening osteotomy is a good option to treat patients with ulnar impaction syndrome regardless of the distal radioulnar joint angle.Level of evidence: IV.

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education.