scholarly journals Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna

2017 ◽  
Vol 07 (04) ◽  
pp. 344-349 ◽  
Author(s):  
Bernhard Rozée ◽  
Ahmed Elgammal
Keyword(s):  
Grip Strength ◽  
Dynamic Compression ◽  
Dash Score ◽  
Ulnar Osteotomy ◽  
Soft Tissue Dissection ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Compression Plate ◽  
Ulnar Impaction Syndrome

Background The purpose of this study is to evaluate the results of patients with ulnar impaction syndrome treated with diaphyseal osteotomy using freehand technique and fixation with ulnar osteotomy compression plate placed on the ulnar surface of the ulna. Materials and Methods A retrospective chart review of patients with ulnar impaction syndrome between 2010 and 2014 identified 38 patients. The following clinical data were observed: patient age, sex, range of motion, grip strength, visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological assessment, and complications. The mean follow-up period is 30 months. Eleven patients were excluded from the study. Results Compared with the contralateral side, the 27 patients included in this study attained 93 to 96% of wrist and forearm motion and 81% of the grip strength. The average DASH score was 18 in a mean follow-up period of 30 months. Three patients required plate removal and one case showed nonunion and a further operation was needed. Two patients reported persistent ulnar-sided wrist pain. Conclusion We concluded that placing the ulnar osteotomy plate on the ulnar surface of the ulna is a quicker procedure, with less soft tissue dissection and irritation, and very high union rate. Level of Evidence Level IV.

scholarly journals Changes in Ulnar Variance after a Triangular Fibrocartilage Complex Tear

2018 ◽  
Vol 08 (01) ◽  
pp. 030-036
Author(s):  
Jung-In Shim ◽  
Jin-Hyung Im ◽  
Han-Vit Kang ◽  
Sung-Hyun Cho ◽  
Joo-Yup Lee
Keyword(s):  
Grip Strength ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Group A ◽  
Triangular Fibrocartilage ◽  
Group B ◽  
Ulnar Impaction Syndrome

Purpose The relationship between triangular fibrocartilage complex (TFCC) tear and ulnar impaction syndrome has not been fully understood. We hypothesized that a TFCC tear could change the ulnar variance, which may be the cause of ulnar impaction syndrome. Patients and Methods A total of 72 patients who underwent TFCC foveal repair between January 2011 and June 2016 were included in this retrospective study. Among them, 44 patients diagnosed with TFCC foveal tear with distal radioulnar joint instability and no ulnar impaction syndrome underwent TFCC foveal repair only (group A) and 28 patients diagnosed with TFCC foveal tear with ulnar impaction syndrome underwent TFCC foveal repair and ulnar shortening osteotomy simultaneously (group B). We measured their ulnar variances in preoperative, postoperative, and last follow-up plain radiography. We also compared them with the ulnar variance of the contralateral (uninjured) wrist. Postoperative clinical outcomes, such as range of motions of the wrist, the visual analog scale (VAS) for pain, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, were assessed. Results Ulnar variance increased after TFCC tears compared with that on the uninjured side in both groups (group A: 0.98 vs. 0.52 mm, p = 0.013; group B: 2.71 vs. 2.13 mm, p = 0.001). Once the TFCC was repaired, ulnar variance decreased (group A: 0.98 to 0.01 mm, p < 0.01; group B: 2.71 to 0.64 mm, p < 0.01). However, it was increased on the last follow-up radiograph (group A: 0.01 to 0.81 mm, p < 0.01; group B: 0.64 to 1.05 mm, p = 0.004). There were no significant improvement of range of motion, except for pronation–supination motion (p = 0.04). Mean grip strength increased from 56.8 to 70.8% of the contralateral unaffected hand at the last assessment (p = 0.01). Mean VAS for pain decreased from 7.4 ± 2.5 preoperatively to 2.7 ± 2 postoperatively (p = 0.001). The QuickDASH score significantly improved from 45 to 9 (p = 0.001). Conclusion Ulnar variance may be changed after a TFCC tear. In our study, it decreased after TFCC foveal repair. However, as time went on, the ulnar variance increased again, which could be one of the causes of ulnar impaction syndrome and ulnar-sided wrist pain. Level of Evidence This is a therapeutic Level IV study.

scholarly journals How to Achieve Faster Osteotomy Healing and Prevent Refracture after Ulnar Shortening Osteotomy?

2020 ◽  
Author(s):  
Jong woo Kang ◽  
Soo Min Cha ◽  
Sang-gyun Kim ◽  
In Cheul Choi ◽  
Dong Hun Suh ◽  
...  
Keyword(s):  
Dynamic Compression ◽  
Factors Affecting ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Osteotomy Technique ◽  
Baseline Characteristics ◽  
Group 2 ◽  
Ulnar Impaction Syndrome ◽  
Group 1

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 and 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 were not different between the two groups. The osteotomy reduction gap, 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 a guided osteotomy was beneficial to reducing the osteotomy reduction gap during USO.

scholarly journals Ulnar Shortening Versus Distal Radius Corrective Osteotomy in the Management of Ulnar Impaction After Distal Radius Malunion

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 194-201 ◽  
Author(s):  
William R. Aibinder ◽  
Ali Izadpanah ◽  
Bassem T. Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Tourniquet Time ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Significant Difference ◽  
Distal Radius Malunion ◽  
Ulnar Impaction Syndrome ◽  
Radius Malunion

Background: Distal radius malunions lead to functional deficits. This study compares isolated ulnar shortening osteotomy (USO) to distal radius osteotomy (DRO) for the treatment of ulnar impaction syndrome following distal radius malunion. Methods: We retrospectively reviewed 11 patients with extra-articular distal radius malunions treated for ulnar impaction with isolated USO. This group was compared to a 1:1 age- and sex-matched cohort treated with isolated DRO for the same indication. Pain visual analog scale (VAS), wrist motion, grip strength, radiographic parameters, and perioperative complications were analyzed. Mean follow-up was 14.8 months. Results: VAS scores improved. Wrist range of motion improved in both cohorts with the exception of radial deviation, pronation, and supination in the USO cohort, which decreased from a mean of 17°-16°, 67°-57°, and 54°-52°, respectively. There was no significant difference between groups in regard to change in pain or range of motion, with the exception of pronation and ulnar deviation. The mean tourniquet time was shorter in the USO group. The final ulnar variance was 1.8 mm negative in the USO group and 1.1 mm positive in the DRO group. There was 1 reoperation following USO for painful nonunion, while there were 2 reoperations following DRO for persistent ulnar impaction. Conclusions: An improvement in range of motion, grip strength, and VAS with restoration of the radioulnar length relationship was observed in both cohorts. USO is a simpler procedure with a shorter tourniquet time that can be an attractive alternative to DRO for ulnar impaction syndrome after distal radius malunions.

scholarly journals Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jong Woo Kang ◽  
Soo Min Cha ◽  
Sang-gyun Kim ◽  
In Cheul Choi ◽  
Dong Hun Suh ◽  
...  
Keyword(s):  
Dynamic Compression ◽  
Factors Affecting ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Osteotomy Technique ◽  
Baseline Characteristics ◽  
Group 2 ◽  
Ulnar Impaction Syndrome ◽  
Group 1

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.

Outcomes of Ulnar Shortening for Ulnar Impaction Syndrome Using the 2.7 mm AO Ulna Shortening Osteotomy System

2018 ◽  
Vol 23 (01) ◽  
pp. 82-89 ◽  
Author(s):  
T. Finnigan ◽  
N. Makaram ◽  
A. Baumann ◽  
K. Ramesh ◽  
R. Mohil ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Bony Union ◽  
Visual Analogue Pain ◽  
Low Profile ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Effective System ◽  
Ulnar Impaction Syndrome

Background: Ulnar shortening osteotomy is a well-established treatment for ulnar impaction syndrome. Controversy remains regarding the most effective system to achieve efficient bony union, whilst minimising incidence of complications, particularly hardware irritation. We present outcomes at 2 years using the recently released low profile AO osteotomy system.Methods: 32 consecutive patients with significant pain from ulnar impaction syndrome (idiopathic or post-traumatic), without degenerative changes of the distal radio-ulnar joint, were included. Time to union, range of motion, grip strength, pain and complications were recorded.Results: Median time to union was 10.14 weeks (9.27–11.01, 95%CI), with one nonunion. Visual Analogue Pain score, grip strength and range of motion improved significantly. No patient experienced hardware irritation. No plate required removal. Positive ulnar variance was reduced by 3.8 mm (mean).Conclusions: The low profile AO system appears effective in achieving bony union whilst minimising incidence of hardware irritation, at a follow up of 2 years

scholarly journals Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

2011 ◽  
Vol 3 (4) ◽  
pp. 295 ◽  
Author(s):  
Goo Hyun Baek ◽  
Hyuk Jin Lee ◽  
Hyun Sik Gong ◽  
Seung Hwan Rhee ◽  
Jihyeung Kim ◽  
...  
Keyword(s):  
Long Term Outcomes ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Ulnar Impaction Syndrome

scholarly journals Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hui-Kuang Huang ◽  
Steve K. Lee ◽  
Yi-Chao Huang ◽  
Cheng-Yu Yin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Inclination Angle ◽  
Functional Outcomes ◽  
Functional Evaluation ◽  
Sigmoid Notch ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Ulnar Impaction Syndrome

Abstract Background Ulnar 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. Methods We 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. Results We 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. Conclusions 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 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.

scholarly journals Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

2017 ◽  
Vol 07 (02) ◽  
pp. 133-140 ◽  
Author(s):  
Alexandra Herold ◽  
Frank Unglaub ◽  
Kai Megerle ◽  
Holger Erne ◽  
Steffen Löw
Keyword(s):  
Wrist Pain ◽  
Level Of Evidence ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Shortening Osteotomy ◽  
Significant Difference ◽  
Triangular Fibrocartilage ◽  
Improved Function ◽  
Ulnar Impaction Syndrome

Background Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view. Purpose This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion. Patients and Methods Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal. Results In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups. Conclusion In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure. Level of Evidence Therapeutic III, case–control study.

Results of the Wafer Procedure for Ulnar Impaction Syndrome in the Ulnar Negative and Neutral Wrist

1999 ◽  
Vol 24 (6) ◽  
pp. 671-675 ◽  
Author(s):  
M. M. TOMAINO
Keyword(s):  
Pain Relief ◽  
Functional Outcome ◽  
Grip Strength ◽  
Functional Restoration ◽  
Distal Ulna ◽  
Ulnar Impaction ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Ulnar Impaction Syndrome

Thirteen wrists with ulnar neutral or negative variance were treated by open distal ulna excision (the wafer procedure). The mean follow-up was 25 months (range, 12–38). At final follow-up grip strength had increased a mean of 14 kgf and 12 of the 13 patients were very satisfied with the functional outcome and pain relief. In treatment of the ulnar impaction syndrome, the wafer procedure provides excellent pain relief and functional restoration particularly in patients with ulnar neutral or negative wrists in whom triangular fibrocartilage tears have not yet developed.

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