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For: Owens J, Compton J, Day M, Glass N, Lawler E. Nonunion Rates Among Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome: A Systematic Review. J Hand Surg Am 2019;44:612.e1-612.e12. [PMID: 30342784 DOI: 10.1016/j.jhsa.2018.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/06/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]

For:	Owens J, Compton J, Day M, Glass N, Lawler E. Nonunion Rates Among Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome: A Systematic Review. J Hand Surg Am 2019;44:612.e1-612.e12. [PMID: 30342784 DOI: 10.1016/j.jhsa.2018.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/06/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]

Number

Cited by Other Article(s)

Xu W, Ho PC, Nakamura T, Ecker JO, Fujio K, Lee JY, Chen S, Koo SCJJ, Chan PT, Chin AYH, Lee YK, Shih JT, Tse WL, Wahegaonkar AL, Chen Y. Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024). J Wrist Surg 2025;14:2-13. [PMID: 39896902 PMCID: PMC11781854 DOI: 10.1055/s-0044-1787156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/29/2024] [Indexed: 02/04/2025]

Affiliation(s)

Wendong Xu Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China
Pak Cheong Ho Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Hongkong SAR, People's Republic of China
Toshiyasu Nakamura Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
Jeffrey Oscar Ecker Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Hand and Upper Limb Centre and Wrist + Hand Institute, Perth, Australia
Keiji Fujio Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedics, Kyoto University, Kyoto, Japan
Joo Yup Lee Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, Seoul, South Korea
Shanlin Chen Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, People's Republic of China
Siu Cheong Jeffrey Justin Koo Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hongkong SAR, People's Republic of China
Ping Tak Chan Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedics and Traumatology, Tuen Mun Hospital, Hongkong SAR, People's Republic of China
Andrew Yuan Hui Chin Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore, Singapore
Young Kuen Lee Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedic Surgery, Chonbuk National University Medical School, Jeonju, Korea
Jui Tien Shih Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedic Surgery, Centre for Sports Medicine Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, People's Republic of China
Wing Lim Tse Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hongkong SAR, People's Republic of China
Abhijeet L. Wahegaonkar Asian Pacific Wrist Association, Hongkong SAR, People's Republic of China Division of Hand and Microvascular Services, Sancheti Hospital, Pune, Maharashtra, India
Yaolong Chen Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, People's Republic of China Lanzhou University GRADE Center, Lanzhou, People's Republic of China

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Zhang Y, Grewal R, Vergouwen M, Lu S, White N. Risk Factors for Complications in Ulnar Shortening Osteotomies: A Multicenter Retrospective Review. J Hand Surg Am 2025;50:104.e1-104.e7. [PMID: 37436341 DOI: 10.1016/j.jhsa.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023]

Abstract

PURPOSE

Ulnar shortening osteotomy (USO) is commonly performed to alleviate pathologies causing ulnar-sided wrist pain. Surgical complications include nonunion and hardware removal, with rates up to 18% and 45%, respectively. The primary objective of the study was to report the overall complication rate of USO. The secondary objective was to identify risk factors for complications.

METHODS

A retrospective multicenter cohort review was undertaken, including six Canadian cities over a 6-year period (January 2013-December 2018). Chart review was used to collect demographic data, surgical technique, implant used, and postoperative complications. Descriptive statistics of demographics and operative characteristics, including plate positioning, type of osteotomy, plate type, and ulnar variance (mm), were analyzed. Univariate analyses were used to select predictor variables for nonunion and hardware removal. These predictor variables were then entered into an adjusted multivariable logistic regression model.

RESULTS

A total of 361 USOs were performed. Mean age was 46 ± 16 years (60.7% men). The overall complication rate was 37.1%, hardware removal rate was 29.6%, and nonunion rate was 9.4%. There was a workers' compensation claim associated with 21.6% of all complications, and it was a risk factor for both hardware removal (odds ratio [OR] = 3.81) and nonunion (OR = 2.88). Neither smoking nor diabetes was associated with complication rates. Seventy percent of plates were placed volarly, 25.5% dorsally, and 3.9% directly ulnar. Osteotomies were oblique in 83.7% of cases and transverse in 15.5%. Adjusted multivariate regression analysis revealed that younger age (OR = 0.98) was a risk factor for hardware removal and male sex (OR = 2.49) was a risk factor for nonunion. A surgical factor associated with hardware removal was direct ulnar plate placement (OR = 9.93). No surgical factors were associated with nonunions.

CONCLUSIONS

There are substantial rates of complications with USOs. Direct ulnar plate placement should be avoided. Patients should be thoroughly counseled on the risks of complications prior to proceeding with USO.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

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Miyashima Y, Uemura T, Okada M, Saito K, Nakamura H. Comparison of dynamic compression plate systems with oblique osteotomy and locking plate fixation versus transverse osteotomy and non-locking plate fixation for ulnar shortening osteotomy. J Orthop Sci 2024:S0949-2658(24)00264-1. [PMID: 39658455 DOI: 10.1016/j.jos.2024.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 10/17/2024] [Accepted: 11/13/2024] [Indexed: 12/12/2024]

Abstract

BACKGROUND

Ulnar shortening osteotomy (USO) is a well-established surgical technique for ulnar impaction syndrome and triangular fibrocartilage complex injuries, but complications like delayed union and nonunion are often encountered. Transverse and oblique osteotomy techniques are commonly used, yet direct comparisons using advanced implants are limited. This study aims to compare the clinical and radiological outcomes of USO using the Jplate with a transverse osteotomy device and the APTUS Wrist Ulna Shortening System 2.5 with an oblique osteotomy device.

METHODS

We retrospectively reviewed 37 patients who underwent USO (15 and 22 treated with the Jplate and APTUS systems, respectively) from July 2009 to October 2022. Clinical outcomes were measured using the visual analog scale (VAS), grip strength, range of motion, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Hand20 scores. Radiological outcomes included time to bone union, delayed union, and nonunion rates. Statistical analyses involved Mann-Whitney and Kruskal-Wallis tests and multivariable linear regression models adjusted for age, sex, and smoking status.

RESULTS

Time to union was faster in the APTUS group compared to the Jplate group, with a significantly higher delayed union rate in the Jplate group than in the APTUS group. Postoperative pain reduction was significantly greater in the APTUS group compared to the Jplate group. Improvements in Hand20 scores were also significantly higher in the APTUS group compared to the Jplate group. Multivariable regression analyses confirmed that the APTUS system significantly shortened time to union and improved VAS and Hand20 scores.

CONCLUSIONS

The APTUS system provides superior clinical and radiological outcomes compared to the Jplate, with significant reductions in delayed union rates and postoperative pain and earlier bone healing. This system enables oblique osteotomy and compression of the osteotomy site with a single device, which may have contributed to the observed differences in our study.

LEVEL OF EVIDENCE

Level 4.

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Laane CLE, Oude Nijhuis KD, Spil J, Sierevelt IN, Doornberg JN, Jaarsma RL, Verhofstad MHJ, Wijffels MME. What Surgical Technique to Perform for Isolated Ulnar Shortening Osteotomy After Distal Radius Malunion: A Systematic Review. Hand (N Y) 2024;19:885-894. [PMID: 36794764 PMCID: PMC11342711 DOI: 10.1177/15589447231152587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]

Abstract

BACKGROUND

Unstable fractures of the distal radius fractures (DRFs) may result in malunion, usually consisting of subsequent shortening and angular deviations. Ulnar shortening osteotomy (USO) is assumed to be a simpler procedure than radial correction osteotomy, resulting in fewer complications and comparable outcomes. The aim of this study was to identify the best surgical technique to perform USO to restore distal radioulnar joint congruency after DRF malunion.

METHODS

A systematic review of the literature is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in February 2022 to identify studies reporting outcomes and surgical technique for isolated USO. The primary outcome was complication rates. Secondary outcomes included functional, radiologic, and patient-rated outcomes. The methodological index for nonrandomized studies criteria were used to assess the quality of evidence.

RESULTS

Included were 12 cohorts (185 participants). Due to substantial heterogeneity, a meta-analysis could not be performed. The overall complication rate was 33% (95% confidence interval, 16% to 51%). The most reported complication was implant irritation (22%), often requiring removal of the implant (13%). Only 3% nonunions were mentioned. Functional and patient-rated outcomes improved in most patients after USO. Quality of evidence of the papers was low to very low. Common methodological flaws were related to retrospective research.

CONCLUSION

No evident differences in complication rates and functional outcomes between the surgical techniques were observed. Based on this literature, most complications are related to implant irritation. Nonunion and infection rates were rare. Therefore, a surgical technique with a buried implant might be preferred. This hypothesis requires further investigation.

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Frey CS, Zhou JY, Shah KN, Chan CK, Joseph L, Storaci H, Segovia N, Yao J. Distal Metaphyseal Ulnar Shortening Osteotomy Fixation: A Biomechanical Analysis. J Hand Surg Am 2024;49:928.e1-928.e7. [PMID: 36599794 DOI: 10.1016/j.jhsa.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023]

Abstract

PURPOSE

Ulnar shortening osteotomy can be used to treat ulnar impaction syndrome and other causes of ulnar wrist pain. Distal metaphyseal ulnar shortening osteotomy (DMUSO) is one technique that has been proposed to reduce the complications seen with a diaphyseal USO or a wafer resection. However, to our knowledge, the optimal fixation construct for DMUSO has not been studied. We sought to characterize the biomechanical stiffness and rotational stability of different DMUSO constructs.

METHODS

A DMUSO was performed on 40 human cadaveric ulnas using 4 different fixation constructs (10 specimens per group): one 3.0 mm antegrade screw; two 2.2 mm antegrade screws; one 3.0 mm retrograde screw; and two 2.2 mm retrograde screws. Biaxial testing using axial load and cyclical axial torque was performed until failure, defined as 10° of rotation or 2 mm displacement. Specimens were assessed for stiffness at failure. Bone density was assessed using the second metacarpal cortical percentage.

RESULTS

Bone density was similar between all 4 testing groups. Of the 4 groups, the 2 antegrade screw group exhibited the highest rotational stiffness of 232 ± 102 Nm/deg. In paired analysis, this was significantly greater than 1 retrograde screw constructs. In multivariable analysis, 2-screw constructs were significantly stiffer than 1 screw and antegrade constructs were significantly stiffer than retrograde. Maximum failure torque did not differ with orientation, but 2 screws failed at significantly higher torques.

CONCLUSION

Using 2 screws for DMUSO fixation constructs may provide higher stiffness and maximum failure torque, and antegrade screw constructs may provide more stiffness than retrograde constructs.

CLINICAL RELEVANCE

Antegrade screw fixation using 2 screws may provide the strongest construct for DMUSO. Antegrade fixation may be preferred because it avoids violating the distal radioulnar joint capsule and articular surface of the ulna.

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Hansen LM, Lindahl AC, Eller EB, Day CS. Cutibacterium acnes Infection as a Cause of Nonunion After Ulnar-Shortening Osteotomy. Orthopedics 2024;47:e211-e213. [PMID: 39038106 DOI: 10.3928/01477447-20240609-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]

Chen KL, Yin CY, Huang HK, Huang YC, Wang JP. Enabling the design of surgical instruments for under-resourced patients through metal additive manufacturing: ulnar shortening osteotomy as an example. 3D Print Med 2024;10:18. [PMID: 38819766 PMCID: PMC11141050 DOI: 10.1186/s41205-024-00220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024] Open

Abstract

BACKGROUND

Ulnar shortening osteotomy (USO) has demonstrated good outcomes for patients with ulnar impaction syndrome. To minimize complications such as non-union, precise osteotomy and firm fixation are warranted. Despite various ulnar shortening systems have been developed, current technology does not meet all needs. A considerable portion of patients could not afford those designated USO systems. To tackle this challenge, our team reported successful results in standardized free-hand predrilled USO technique. However, it is still technical demanding and requires sufficient experience and confidence to excel. Therefore, our team designed an ulnar shortening system based on our free-hand technique principle, using metal additive manufacturing technology. The goal of this study is to describe the development process and report the performance of the system.

METHODS

Utilizing metal additive manufacturing technology, our team developed an ulnar shortening system that requires minimal exposure, facilitates precise cutting, and allows for the easy placement of a 3.5 mm dynamic compression plate, available to patients at zero out-of-pocket cost. For performance testing, two surgeons with different levels of experience in ulnar shortening procedures were included: one fellow-trained hand and wrist surgeon and one senior resident. They performed ulnar shortening osteotomy (USO) using both the free-hand technique and the USO system-assisted technique on ulna sawbones, repeating each method three times. The recorded parameters included time-to-complete-osteotomy, total procedure time, chip diameter, shortening length, maximum residual gap, and deviation angle.

RESULTS

For the hand and wrist fellow, with the USO system, the time-to-complete osteotomy was significantly reduced. (468.7 ± 63.6 to 260.0 ± 5 s, p < 0.05). Despite the preop goal was shortening 3 mm, the average shortening length was significantly larger in the free-hand group (5 ± 0.1; 3.2 ± 0.2 mm, p < 0.05). Both maximum residual gap and deviation angle reported no statistical difference between the two techniques for the hand surgeon. As for the senior resident, the maximum residual gap was significantly reduced, using the USO system (2.9 ± 0.8; 0.4 ± 0.4 mm, p = 0.02). Between two surgeons, significant larger maximum residual gap and deviation angle were noted on the senior resident doctor, in the free-hand technique group, but not in the USO system group.

CONCLUSION

The developed USO system may serve as a valuable tool, aiding in reliable and precise cutting as well as fixation for patients undergoing ulnar shortening osteotomy with a 3.5 mm dynamic compression plate, even for less experienced surgeons. The entire process, from concept generation and sketching to creating the CAD file and final production, serves as a translatable reference for other surgical scenarios.

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Kim KW, Kim JH, Lim HR, Bae KJ, Lee YH, Shin YK, Baek GH. Outcomes of Ulnar Shortening Osteotomy with an Intramedullary Bone Graft for Idiopathic Ulnar Impaction Syndrome. Clin Orthop Surg 2024;16:313-321. [PMID: 38562625 PMCID: PMC10973609 DOI: 10.4055/cios23266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 04/04/2024] Open

Abstract

Background

Although several techniques for the treatment of ulnar impaction syndrome (UIS) have been introduced, there have still been reports on various complications such as delayed union, nonunion, refracture, wrist pain, plate irritation, and chronic regional pain syndrome. This study aimed to compare the differences in radiological and clinical outcomes of patients in which intramedullary bone grafting was performed in addition to plate stabilization with those without additional bone grafting during ulnar shortening osteotomies (USOs).

Methods

Between November 2014 and June 2021, 53 wrists of 50 patients with idiopathic UIS were retrospectively reviewed. Patients were divided into 2 groups according to whether intramedullary bone grafting was performed. Among the 53 wrists, USO with an intramedullary bone graft was performed in 21 wrists and USO without an intramedullary bone graft was performed in 32 wrists. Demographic data and factors potentially associated with bone union time were analyzed.

Results

There was no significant difference between the 2 groups when comparing postoperative radioulnar distance, postoperative ulnar variance, amount of ulnar shortening, and postoperative Disabilities of the Arm, Shoulder and Hand score. Compared to the without-intramedullary bone graft group, bone union time of the osteotomy site was significantly shortened, from 8.8 ± 3.0 weeks to 6.7 ± 1.3 weeks in the with-intramedullary bone graft group. Moreover, there were no cases of nonunion or plate-induced symptoms. Both in univariable and multivariable analyses, intramedullary bone grafting was associated with shorter bone union time.

Conclusions

USO with an intramedullary bone graft for idiopathic UIS has favorable radiological and clinical outcomes. The advantage of this technique is the significant shortening of bone union time.

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Daoulas T, Bernard M, Dellestable A, Letissier H, Bacle G, Sos C. Consolidation rate in ulnar shortening osteotomy with the APTUS Wrist plate. HAND SURGERY & REHABILITATION 2024;43:101682. [PMID: 38492803 DOI: 10.1016/j.hansur.2024.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]

Rozental TD, Watkins IT. Principles and Evaluation of Bony Unions. Hand Clin 2024;40:1-12. [PMID: 37979981 DOI: 10.1016/j.hcl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]

Pereira GF, Fletcher AN, O’Donnell JA, Whitlock KG, Shapiro LM, Pidgeon TS, Ruch DS, Richard MJ. Ulnar Resection Length: A Risk Factor for Nonunion in Ulnar Shortening Osteotomy. Hand (N Y) 2024;19:74-81. [PMID: 36068943 PMCID: PMC10786108 DOI: 10.1177/15589447221122827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Shariyate MJ, Afshar A, Nazarian A, Kachooei AR. Sliding Plate System: A Novel Method and Device for Shortening Osteotomy. J Hand Surg Asian Pac Vol 2023;28:600-604. [PMID: 37881821 DOI: 10.1142/s2424835523710078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]

Ha JW, Kwon YW, Lee S, Lim H, Lee J, Lim CK, Lee JK. Is ulnar shortening osteotomy or the wafer procedure better for ulnar impaction syndrome?: A systematic review and meta-analysis. Medicine (Baltimore) 2023;102:e35141. [PMID: 37773809 PMCID: PMC10545262 DOI: 10.1097/md.0000000000035141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/18/2023] [Indexed: 10/01/2023] Open

Zhou JY, Frey CS, Shah KN, Ostergaard PJ, Yao J. Antegrade Fixation of Distal Metaphyseal Ulnar Shortening Osteotomy. Tech Hand Up Extrem Surg 2023;27:182-188. [PMID: 37185273 DOI: 10.1097/bth.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]

Stirling PHC, Oliver WM, Ng N, Oliver CW, McQueen MM, Molyneux SG, Duckworth AD. Distal radius malunion: outcomes following an ulnar shortening osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023;33:1635-1640. [PMID: 35794424 PMCID: PMC10276056 DOI: 10.1007/s00590-022-03325-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]

Bui G, Rogers MJ, Shigley C, Huang JI. Staple Fixation in Ulnar-Shortening Osteotomies. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023;5:477-482. [PMID: 37521548 PMCID: PMC10382933 DOI: 10.1016/j.jhsg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 08/01/2023] Open

Deng HL, Lu ML, Tang ZM, Mao QL, Zhao JM. Is metaphyseal ulnar shortening osteotomy superior to diaphyseal ulnar shortening osteotomy in the treatment of ulnar impaction syndrome? A meta-analysis. World J Clin Cases 2023;11:2753-2765. [PMID: 37214579 PMCID: PMC10198107 DOI: 10.12998/wjcc.v11.i12.2753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open

Abstract

BACKGROUND

Although metaphyseal ulnar shortening osteotomy (MUSO) is safer for the treatment of ulnar impaction syndrome (UIS) than diaphyseal ulnar shortening osteotomy (DUSO), DUSO is widely used for UIS treatment.

AIM

To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.

METHODS

Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE (Ovid), PubMed, EMBASE, and Cochrane Library. The demography, incidence of complications, secondary operation rate, postoperative DASH score, wrist pain on the visual analogue scale, and grip strength improvement were also evaluated. In addition, the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed. The outcome of the patient was discontinuous, and the odds ratio, risk ratio (RR), and 95%CI were calculated and analyzed via RevMan5.3 software.

RESULTS

Six studies, including 83 patients receiving MUSO (experimental group) and 112 patients receiving DUSO (control group), were included in the meta-analysis. The second operation rate was significantly higher after DUSO than after MUSO. The DASH scores were slightly lower in the MUSO group than in the DUSO group. The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO. However, the incidence of complications and improvement of grip strength were not significantly different between the two groups.

CONCLUSION

Although DUSO and MUSO provide similar effects for UIS, MUSO is associated with a lower secondary operation rate, slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO, indicating that MUSO can effectively be used for UIS treatment.

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Facon JB, Mainard N, Faure PA, Wavreille G, Chantelot C, Auzias P. Results of isolated ulnar shaft shortening osteotomy in the treatment of idiopathic ulnocarpal impaction syndrome. HAND SURGERY & REHABILITATION 2022;41:589-594. [PMID: 35907617 DOI: 10.1016/j.hansur.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]

Lohre R, Daneshvar P. Radiographic Determination of the Distal Ulnar Diaphyseal Angle. J Hand Surg Am 2022;47:1015.e1-1015.e9. [PMID: 35027263 DOI: 10.1016/j.jhsa.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]

Abstract

PURPOSE

Characterizing the distal ulnar diaphyseal angle (DUDA) may be important for anatomic recreation of the distal ulna during ulnar shortening osteotomy procedures using conventional straight plates. This study characterized the DUDA and determined side-to-side, age, and sex effects on DUDA magnitudes and locations.

METHODS

Retrospective analyses of bilateral wrist radiographs were performed on 60 patients. The DUDA was defined as the angle of intersection between a line passing through the center of the distal ulnar metadiaphyseal region, in line with the landmarked long axis of the ulna, on a lateral radiograph. This inflection point was measured from the most distal aspect of the ulnar head and recorded as the DUDA tip-to-apex distance (TAD). Rater reliability was determined using the intraclass correlation coefficient.

RESULTS

We found DUDAs in 94% of radiographs. The mean DUDA angle was 5.6° ± 2.6° and the mean TAD was 45.3 ± 9.5 mm. The Pearson correlation coefficients for side-to-side comparisons were 0.47 for the DUDA angle and 0.69 for the TAD. For male and female patients, the mean DUDAs were 5.4° ± 2.3° and 5.9° ± 2.9°, respectively, and the mean TADs were 47.8 ± 9.7 mm and 41.7 ± 7.9 mm, respectively. The DUDA angle and TAD had negligible associations with age (r = -0.15 and -0.08, respectively). At 0.74 (95% CI, 0.58-0.85), interrater reliability was good. At 0.93 (95% CI, 0.88-0.96), intrarater reliability was excellent.

CONCLUSIONS

We demonstrated DUDAs, representing valgus deviations from the center axis and anteroposterior views of the ulna. Contralateral lateral wrist radiographs are moderate to strongly reliable in determining a DUDA. Rater reliability was good to excellent.

CLINICAL RELEVANCE

Re-creation of the DUDA may benefit procedures such as ulnar shortening osteotomy, fractures, or malunion by contributing to knowledge of distal radioulnar joint biomechanics.

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Lu C, Wang P, Zhang L, Dong J, Zhang H, Yang L, Wang X, Xiong H. Clinical Study of Wrist Arthroscopy Combined with Oblique Ulnar Shortening Osteotomy in the Treatment of Ulnar Impaction Syndrome. Orthop Surg 2022;14:2947-2954. [PMID: 36178102 PMCID: PMC9627053 DOI: 10.1111/os.13428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open

Abstract

Objective

To explore the clinical effects of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome.

Methods

This was a retrospective study of 60 patients with ulnar impaction syndrome who were admitted to our department from January 2016 to December 2019. According to different surgical methods, they were divided into an observation group and a control group, with 30 cases in each group. The control group was treated with oblique ulnar shortening osteotomy, and the observation group used wrist arthroscopy based on the control group. The two groups of patients were compared in terms of wrist function before and 12 months after surgery. We compared the Disabilities of the Arm, Shoulder, and Hand Score (DASH Score), Patient‐Rated Wrist Evaluation Score (PRWE Score), Visual Analog Score (VAS), and ulnar variation between the two groups at 12 months after surgery. The excellent and good rates by Mayo wrist score were compared between the two groups at the last follow‐up.

Results

All patients were followed up for 12–36 months, with an average of 14.5 months. Bone union was achieved at the oblique osteotomy of the ulna, with an average healing time of 13.6 weeks. The observation group was examined by wrist arthroscopy, and the triangular fibrocartilage complex (TFCC) Palmer classification was confirmed in three cases of type IIA, seven cases of type IIB, 14 cases of type IIC, and six cases of type IID. Compared with before surgery, the grip strength, flexion‐extension, ulnar radial deflection, and forearm rotation of the two groups of patients were significantly improved at 12 months after surgery. The DASH score, PRWE score, and VAS score of the observation group were better than those of the control group, and the difference in ulnar shortening length was not statistically significant between the two groups. The excellent and good rates of the observation group (93.3%) were better than those of the control group (87.5%) at the last follow‐up, and the difference was statistically significant.

Conclusion

Compared with oblique ulnar shortening osteotomy alone, combined wrist arthroscopy can better reduce the pain of patients with ulnar impaction syndrome, restore wrist function, and improve the excellent and good rates. Therefore, it is clinically worthy of promotion.

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Moeller RT, Mentzel M, Vergote D, Bauknecht S. [Ulnar Shortening Osteotomy - Two Weeks of Immobilization Sufficient]. HANDCHIR MIKROCHIR P 2022;54:434-441. [PMID: 36037818 DOI: 10.1055/a-1894-7149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open

Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years. Bone Jt Open 2022;3:375-382. [PMID: 35514114 PMCID: PMC9134835 DOI: 10.1302/2633-1462.35.bjo-2022-0031.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open

Abstract

Aims

The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome.

Methods

Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores.

Results

Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%).

Conclusion

Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common.

Cite this article: Bone Jt Open 2022;3(5):375–382.

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Wang J, Yin Y, Sun C, Wu R, Luo T, Che J, Bu J. The association of three anatomical factors with ulnar-sided wrist pain: a radiological study. Acta Radiol 2022;64:250-256. [PMID: 35108123 DOI: 10.1177/02841851221076331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

Teunissen JS, Wouters RM, Al Shaer S, Zöphel OT, Vermeulen GM, Hovius SER, Van der Heijden EPA. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients. J Orthop Traumatol 2022;23:1. [PMID: 34985595 PMCID: PMC8733117 DOI: 10.1186/s10195-021-00621-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/27/2021] [Indexed: 12/30/2022] Open

Abstract

Background

Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology.

Materials and methods

We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool.

Results

The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion.

Conclusion

We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO.

Level of evidence

Therapeutic III.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10195-021-00621-8.

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Kang JW, Cha SM, Kim SG, Choi IC, Suh DH, Park JW. Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy. J Orthop Surg Res 2021;16:110. [PMID: 33541409 PMCID: PMC7863478 DOI: 10.1186/s13018-021-02266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open

Abstract

BACKGROUND

Parallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO.

METHODS

Between June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated.

RESULTS

The baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy.

CONCLUSIONS

The minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.

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Ross PR, Chung KC. Instability in the Setting of Distal Radius Fractures: Diagnosis, Evaluation, and Treatment. Hand Clin 2020;36:417-427. [PMID: 33040954 DOI: 10.1016/j.hcl.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]

Whitlock K, Ruch DS. Editorial Commentary: Ulnar Variance Is Not the Sole Determinant of Arthroscopic Wrist Triangular Fibrocartilage Complex Repair Outcome: Considering the Forest From the Ulnar-Positive Tree. Arthroscopy 2020;36:2423-2424. [PMID: 32891244 DOI: 10.1016/j.arthro.2020.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]