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

Consolidation rate in ulnar shortening osteotomy with the APTUS Wrist plate

INTRODUCTION

Ulnocarpal impaction syndrome causes pain on the ulnar side of the wrist. Various surgical techniques have been described. Ulnar shortening osteotomy is now a standard treatment. However, it is associated with complications such as non-union of the osteotomy site. The main study objective was to report the rate of radiographic consolidation after ulnar shortening osteotomy with a cutting guide.

MATERIAL AND METHODS

This multicenter retrospective study of 30 cases reported clinical and radiographic criteria at a minimum 6 month's follow-up.

RESULTS

The non-union rate was 3.4%. One case presented non-union of the osteotomy site. 87% of patients were satisfied or very satisfied with the procedure. Mean VAS pain rating was 2.7 ± 2.4. Mean QuickDASH and PRWE scores were 24.7 ± 19.2 and 28.6 ± 25. Mean strength on Jamar dynamometer was 27.4 ± 8.9 kg. One patient developed complex regional pain syndrome. Five patients required plate removal for hardware-related discomfort.

DISCUSSION

Ulna shortening osteotomy with the Aptus Wrist plate provides a standardized approach to the surgical treatment of ulnocarpal impaction syndrome. Compared with other series in the literature, the procedure provided satisfactory consolidation and clinical results.

Sliding Plate System: A Novel Method and Device for Shortening Osteotomy

We report a novel sliding plate system (SPS) and its application for radial shortening osteotomy. We conceptualised, designed and introduced the SPS, which helps with precise shortening osteotomy in both radius and ulna. We implanted the SPS in a patient with Kienböck disease following a radius shortening osteotomy. The SPS was safe and efficient, and the surgical technique eliminated extra steps. The SPS affords precise shortening, optimum compression and anatomic alignment after radius shortening osteotomy. Level of Evidence: Level V (Therapeutic).

Is metaphyseal ulnar shortening osteotomy superior to diaphyseal ulnar shortening osteotomy in the treatment of ulnar impaction syndrome? A meta-analysis

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.

The association between plate location and hardware removal following ulna shortening osteotomy: a cohort study

Hardware removal after ulna shortening osteotomy is common. We evaluated the association between plate location and hardware removal rate in 326 procedures in 321 patients with a median follow-up of 4.3 years (IQR 3.3) and corrected for confounding variables and did survival analyses. Complications were scored using the International Consortium for Health Outcome Measurement complications in Hand and Wrist Conditions tool. The 1-year and 5-year reoperation rates for hardware removal were 21% and 46% in the anterior group versus 37% and 64% in the dorsal group. Anterior plate placement was independently associated with a decreased immediate risk of hardware removal. Higher age, male sex and treatment on the dominant side were also associated with a reduced risk of hardware removal. We did not find a difference in hardware removal rates between freehand or jig-guided ulna shortening osteotomies. We noted perioperative problems in 3% of the procedures and complications in 20%.Level of evidence: III.