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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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Affiliation(s)
- Kyung Wook Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Hyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyung Ryul Lim
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Kee Jeong Bae
- Department of Orthopedic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yo Han Lee
- Department of Orthopedic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Kwang Shin
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Goo Hyun Baek
- Department of Hand Surgery, Yeson Orthopaedic Hospital, Bucheon, Korea
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Zhang L, Fu W. A comment on 'Ulnar shortening osteotomy vs. wafer resection for ulnar impaction syndrome: A systematic review and meta-analysis'. Int J Surg 2023; 109:4373-4374. [PMID: 37916929 PMCID: PMC10720770 DOI: 10.1097/js9.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023]
Affiliation(s)
| | - Weili Fu
- Sports Medicine Center, Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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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: 0] [Impact Index Per Article: 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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Affiliation(s)
- Hai-Lin Deng
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ming-Ling Lu
- Ministry of Public Health, Department of Public Health Unit, Liuzhou Liunan District Center for Disease Control, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
| | - Zhe-Ming Tang
- Department of Hand, Foot and Ankle Surgery, Liuzhou Workers' Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
| | - Qing-Long Mao
- Department of Hand, Foot and Ankle Surgery, Liuzhou Workers' Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
| | - Jin-Min Zhao
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Yang H, Qi W, Zhang F, Zhang Q, Liu Y, Lu Z, Mi J, Zhao G. Comparison of diaphyseal and metaphyseal ulnar shortening osteotomies for the treatment of ulnar impaction syndrome. BMC Musculoskelet Disord 2023; 24:10. [PMID: 36609310 PMCID: PMC9817322 DOI: 10.1186/s12891-022-06070-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is a common surgical procedure for the treatment of ulnar impaction syndrome (UIS). The purpose of this study was to compare the results of metaphyseal and diaphyseal USO. METHODS: This retrospective study compared the clinical outcomes and complications of 32 patients who underwent diaphyseal step-cut USO (n = 10), diaphyseal oblique USO (n = 12), or metaphyseal USO (n = 10). RESULTS Patient characteristics, ulnar variance, wrist range of motion, preoperative pain, grip strength, and functional scores (quick disability of the arm, shoulder, and hand and patient-rated wrist evaluation) were comparable. Both operation time (79.5 vs. 138/139 min) and incision length (7.80 vs. 9.67/13.00 cm) were shorter in the metaphyseal USO than in the diaphyseal oblique/step-cut USO. Compared with diaphyseal oblique/step-cut USO, metaphyseal osteotomies were associated with greater improvement in the pain on postoperative day 3 and shorter bone healing time. The requirements for implant removal were the same among the three groups. No complications were observed in any group. CONCLUSION Compared with diaphyseal USO, metaphyseal USO has advantages for operation time and incision length, early postoperative pain, bone healing in UIS management. The results suggested that metaphyseal USO could be widely applied to the surgical treatment of UIS. However, the long-term outcomes of these techniques still require further evaluation using more large-scale, randomized clinical trials.
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Affiliation(s)
- Haoyu Yang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Weiya Qi
- Department of Orthopedics, Xuzhou Renci Hospital, 221000 Xuzhou, China
| | - Fei Zhang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Qian Zhang
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Yuzhou Liu
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Zhengfeng Lu
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Jingyi Mi
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
| | - Gang Zhao
- grid.263761.70000 0001 0198 0694Department of Orthopedics, Wuxi 9th People’s Hospital affiliated to Soochow University, 214000 Wuxi, China
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Teunissen JS, Feitz R, Al Shaer S, Hovius S, Selles RW, Van der Heijden B. Return to Usual Work Following an Ulnar Shortening Osteotomy: A Sample of 111 Patients. J Hand Surg Am 2022; 47:794.e1-794.e11. [PMID: 34511292 DOI: 10.1016/j.jhsa.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to analyze the median time until patients performed their usual work following an ulnar shortening osteotomy (USO). The secondary aim was to identify factors influencing the median time until return to their usual work. METHODS We used a retrospective cohort of patients with ongoing data collection from our institution in the Netherlands. Patients with paid employment who underwent USO were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months after surgery. The probability of and median time until return to usual work were assessed using an inverted Kaplan-Meier analysis. Factors influencing the return to usual work were evaluated using multivariable Cox proportional hazard regression. RESULTS In total, 111 patients who underwent USO were included, with a mean age of 46 years. The probability of returning to usual work in the first year was 92%, and the median time was 12 weeks. The type of work was independently associated with a return to work, with median times of 8, 12, and 14 weeks for light, moderate, and heavy physical work, respectively. We did not find differences in return to usual work based on age, sex, duration of complaints until surgery, treatment side, smoking status, the preoperative Patient-Rated Wrist Evaluation score, or whether the osteotomy was performed freehand or with an external cutting device. CONCLUSIONS Half of the patients that underwent USO fully performed their usual work by 12 weeks following surgery. We found that 92% of the patients performed their usual work within 1 year after surgery. We found a large variation in the time until a return to work based on the type of work. Surgeons can use this data to inform patients on the rehabilitation phase after USO. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Joris Sebastiaan Teunissen
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands.
| | - Reinier Feitz
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Sanharib Al Shaer
- Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Steven Hovius
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Brigitte Van der Heijden
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
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Roulet S, Gubbiotti L, Lakhal W, Chaves C, Marteau E, Laulan J, Bacle G. Ulna shortening osteotomy for ulnar impaction syndrome: Impact of distal radioulnar joint morphology on clinical outcome. Orthop Traumatol Surg Res 2021; 107:102970. [PMID: 34052512 DOI: 10.1016/j.otsr.2021.102970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of ulnar impaction syndrome (UIS) is based on ulnocarpal decompression, which may be achieved by ulna shortening osteotomy. The aim is to restore zero or negative ulnar variance. Tolat et al. described 3 distal radioulnar joint (DRUJ) morphologic types: vertical, oblique and reverse. Joint type has been thought to influence the clinical result of shortening, especially in the reverse type. HYPOTHESIS DRUJ type does not influence clinical results in ulna shortening osteotomy. MATERIAL AND METHODS Twenty-nine wrists were operated on in 27 patients: 13 female, 14 male; mean age at surgery, 43 years (range, 18-72 years). In 20 cases, UIS was idiopathic and in 7 post-traumatic. Mean preoperative ulnar variance was 3.6mm (range, 2-18mm). The osteotomy was fixed by screwed plate. RESULTS Twenty-five patients (27 wrists) were assessed at a mean 64 months (range, 18 months to 13 years). There were no cases of infection or hematoma. DRUJ was type 1 (vertical) in 6 cases (22%), type 2 (oblique) in 14 (52%) and type 3 (reverse) in 7 (26%). Mean postoperative pain score on VAS was 0.7/10 (range, 0-4); 9 wrists remained painful. Mean Quick-DASH was 16.9 (range, 0-48) and mean PRWE 21.9 (range, 16.9-59). Thirteen patients were very satisfied, 11 satisfied, 1 moderately satisfied, and 2 dissatisfied. Mean postoperative ulnar variance was -0.1mm (range, -4 to +8mm). Three wrists developed osteoarthritis, all following traumatic UIS. There were no significant correlations between DRUJ type and other clinical or radiological parameters. DISCUSSION Ulna shortening osteotomy has proven efficacy in UIS. The literature reports excellent or good results in 75% of cases. In the present study, 96% of patients considered themselves cured or improved by surgery, and none reported worsening. Ulna shortening osteotomy can be used in all 3 DRUJ types; DRUJ coronal morphology does not impact clinical result. LEVEL OF EVIDENCE IV-retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France.
| | - Laura Gubbiotti
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Walid Lakhal
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Camilo Chaves
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Emilie Marteau
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Jacky Laulan
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Guillaume Bacle
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
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Abstract
Background: The primary purpose of our study was to identify factors associated with reoperation after ulna shortening osteotomy. Our secondary aims were to determine the rate and type of reoperation procedures. Methods: In this retrospective study, we included patients older than 18 years of age who underwent an ulna shortening osteotomy between January 2003 and December 2015. Medical records of patients were assessed for our explanatory variables, reoperations, and reporting of symptoms. We used bivariate and multivariable analyses to identify factors associated with reoperation after ulna shortening osteotomy. Results: Among 94 patients who underwent 98 ulna shortening osteotomies, there were 34 reoperations (35%). Nineteen patients (19%) underwent removal of hardware, 6 (6.1%) had a nonunion, and 9 (9.2%) underwent additional surgeries. Surgery on their dominant limb, trauma, and prior surgery to the ipsilateral wrist were associated with reoperation. In multivariable analysis, factors independently associated with reoperation were the dominant side being affected (odds ratio = 3.9; 95% confidence interval [CI] = 1.36-11) and traumatic origin (odds ratio = 3.4; 95% CI = 1.1-11). Bivariate analysis identified younger age and prior surgery of the affected wrist as factors associated with hardware removal. More operations for refixation due to nonunion of osteotomy were performed in patients with a transverse osteotomy compared with patients with an oblique osteotomy. Conclusions: One in 3 patients will undergo a reoperation after ulna shortening osteotomy, most often due to hardware irritation or nonunion of osteotomy. Awareness of these rates and predictive factors may be helpful for preoperative discussions and surgical decision making.
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Affiliation(s)
- Svenna H. W. L. Verhiel
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Svenna H. W. L. Verhiel, Research Fellow, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
| | - Sezai Özkan
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyle R. Eberlin
- Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal C. Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Ozasa Y, Iba K, Takahashi N, Wada T, Yamashita T. Comparative Study of Dorsal and Volar Plating for Ulnar Shortening Osteotomy. J Hand Surg Asian Pac Vol 2020; 25:54-58. [PMID: 32000606 DOI: 10.1142/s2424835520500071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Postoperative results of ulnar shortening osteotomy for ulnar abutment syndrome were compared between groups of patients in whom the plate was placed on the volar side and those in whom the plate was placed on the dorsal side. Methods: A total of 35 wrists of 14 males and 21 females were evaluated. The average age of patients at surgery was 44.3 years, and the average follow-up period was 66.2 months. After transverse osteotomy was performed, the ulna was fixed using a 6-hole LC-LCP or a LC-DCP on the dorsal (group D) or the volar (group V) side, respectively. Imaging and clinical results, rates and reasons for implant removal were evaluated. Results: There were 27 patients in group D and 8 in group V. A significant difference was observed only in the postoperative grip strength compared with that of the unaffected side between groups V and D (102% and 87%, respectively). Implant removal was performed in 18 (64%) patients in group D and in 7 (88%) in group V, and the main reasons for this were pain in group V and discomfort in group D. Re-fracture occurred after implant removal in one patient in group D. Conclusions: There were no differences in the imaging and clinical results depending on the plate position. It is preferable to avoid implant removal by placing the lower profile plate on the dorsal side.
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Affiliation(s)
- Yasuhiro Ozasa
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Nobuyuki Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Takuro Wada
- Department of Orthopaedic Surgery, Saiseikai Otaru Hospital, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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Papatheodorou LK, Sotereanos DG. Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome. JBJS Essent Surg Tech 2017; 7:e3. [PMID: 30233938 DOI: 10.2106/jbjs.st.16.00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction The step-cut ulnar shortening osteotomy for the treatment of ulnar impaction syndrome is a safe, reliable, and less expensive technique that uses a 7-hole 3.5-mm standard neutralization plate and a lag screw for fixation, thus avoiding the need for the special instrumentation that other ulnar shortening techniques require. Indications & Contraindications Step 1 Preoperative Planning Perform a physical examination and obtain imaging studies to identify all associated abnormalities. Step 2 Wrist Arthroscopy Video 1 Verify the diagnosis of ulnar impaction syndrome and treat concurrent intra-articular abnormalities. Step 3 Incision for the Ulnar Shortening Osteotomy Video 2 Make a longitudinal skin incision along the distal third of the ulna. Step 4 Design the Step-Cut Ulnar Shortening Osteotomy Video 2 Design the step-cut ulnar shortening osteotomy. Step 5 Perform the Step-Cut Ulnar Shortening Osteotomy Video 2 Create the step-cut ulnar shortening osteotomy using an oscillating saw. Step 6 Fixation of the Osteotomy Video 3 Fix the osteotomy with a lag screw and volar plate. Step 7 Wound Closure Meticulously close the wound in layers. Step 8 Postoperative Care Protect the affected arm for the first 6 weeks. Results In our original study, 164 patients with symptomatic ulnar impaction syndrome were treated with a step-cut ulnar shortening osteotomy using a volar 3.5-mm standard neutralization plate and a lag screw14. Pitfalls & Challenges
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Affiliation(s)
| | - Dean G Sotereanos
- Orthopaedic Specialists-UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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