Clinical, Radiographic, and Arthroscopic Outcomes After Ulnar Shortening Osteotomy: A Long-Term Follow-Up Study

Tatebe, Masahiro; Shinohara, Takaaki; Okui, Nobuyuki; Yamamoto, Masayuki; Hirata, Hitoshi; Imaeda, Toshihiko

doi:10.1016/j.jhsa.2012.09.011

Cited by 32 publications

(23 citation statements)

References 31 publications

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“…31 Ulnar variance affects the load distribution of the wrist. Larger ulnar variance increases the load on the ulnar carpus.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,15,[17][18][19] However, rates of complication can be low if the procedure is properly performed, 5,38 and many papers have actually reported low complication rates. 31,39 New devices to assist with ulnar shortening osteotomy may further reduce the risk of nonunion. 17,19 Several authors have suggested oblique osteotomy 4,10 and step-cut distal ulnar shortening osteotomy, 40 whereas others have performed transverse osteotomy because of its versatility and technical simplicity.…”

Section: Discussionmentioning

confidence: 99%

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Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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The ulnar side of the wrist has been referred to as the "black box" of the wrist, and pathologies of this region have been compared with those of low back pain, 1,2 given the complex anatomy, myriad differential diagnosis, and varied treatment outcomes. Ulnar-sided wrist pain and arise from an acute traumatic injury or a chronic degenerative condition. Common causes of ulnar-sided wrist pain include isolated injuries to the triangular fibrocartilage complex (TFCC) or lunotriquetral ligament as well as ulnar impaction syndrome, which consists of a combination of these 2 conditions along with an Keywords ► ulnar shortening osteotomy ► ulnar-sided wrist pain ► TFCC ► DRUJ ► arthroscopy AbstractBackground The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV

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“…31 Ulnar variance affects the load distribution of the wrist. Larger ulnar variance increases the load on the ulnar carpus.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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“…Furthermore, clinical studies have shown radiographic changes within the DRUJ in 16% to 50% of patients within an average of 18 to 60 months after ulnar shortening procedures. 7,8,21,25 The current study demonstrated that diaphyseal ulnar shortening osteotomy significantly increased transverse DRUJ JRF, whereas distal ulna wafer resection does not affect JRF.…”

Section: Discussionmentioning

confidence: 46%

“…24 Persistently elevated joint contact pressures could also lead to joint degeneration. Several authors 7,8,21,25 have reported degenerative changes at the DRUJ after ulnar shortening osteotomy, with incidences of 16% to 50%. These changes were observed at 2 to 5 years’ follow-up and were not associated with symptoms.…”

Section: Discussionmentioning

confidence: 99%

Distal Radioulnar Joint Reaction Force Following Ulnar Shortening: Diaphyseal Osteotomy Versus Wafer Resection

Canham

Schreck

Maqsoodi

et al. 2015

The Journal of Hand Surgery

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Purpose To compare how ulnar diaphyseal shortening and wafer resection affect distal radioulnar joint (DRUJ) joint reaction force (JRF) using a nondestructive method of measurement. Our hypothesis was that ulnar shortening osteotomy would increase DRUJ JRF more than wafer resection. Methods Eight fresh-frozen human cadaveric upper limbs were obtained. Under fluoroscopic guidance, a threaded pin was inserted into the lateral radius orthogonal to the DRUJ and a second pin was placed in the medial ulna coaxial to the radial pin. Each limb was mounted onto a mechanical tensile testing machine and a distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Data sets were entered into a computer and a polynomial was generated and solved to determine the JRF. This process was repeated after ulnar diaphyseal osteotomy, ulnar re-lengthening, and ulnar wafer resection. The JRF was compared among the 4 conditions. Results Average baseline DRUJ JRF for the 8 arms increased significantly after diaphyseal ulnar shortening osteotomy (7.2 vs 10.3 N). Average JRF after re-lengthening the ulna and wafer resection was 6.9 and 6.7 N, respectively. There were no differences in JRF among baseline, relengthened, and wafer resection conditions. Conclusions Distal radioulnar joint JRF increased significantly after ulnar diaphyseal shortening osteotomy and did not increase after ulnar wafer resection. Clinical relevance Diaphyseal ulnar shortening osteotomy increases DRUJ JRF, which may lead to DRUJ arthrosis.

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“…Ulna-shortening osteotomy has become a popular treatment for a variety of ulnar-sided wrist disorders [1][2][3]. The prevalence of delayed union or nonunion following ulnarshortening osteotomy is a serious problem that cannot be ignored, especially in smokers [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Preservation of Corticoperiosteal Attachment on Bone Healing at Osteotomy Sites after Ulna-shortening Osteotomy

Hamada

Sairyo

Hibino

et al. 2014

Hand (New York, N,Y.)

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Background Although precise ulna-shortening osteotomy is popular, the procedure sometimes results in delayed union or nonunion. The periosteum including the inner cambium layer plays an important role in fracture healing. We tested the hypothesis that preservation of the corticoperiosteal attachment may accelerate healing at osteotomy sites after ulnashortening osteotomy. Methods We performed a chart review of 32 patients who underwent ulna-shortening osteotomy for ulnar impaction syndrome or triangular fibrocartilage complex tears in a retrospective single-surgeon series. Of the 32 cases, the periosteum was preserved in 21 osteotomies performed from April 2009 onwards (periosteum-preserved group) and not preserved in 11 osteotomies performed before April 2009 (control group). Following sugar tong immobilization, patients in both groups used a short wrist supporter during the first two postoperative weeks (POW) and up to at least four POW. Union of the osteotomy site was assessed at 2-week intervals using radiographs taken at three different projections until 12 POW and at 4-week intervals thereafter until 24 POW. Ulna shortening was performed using a transverse osteotomy cut with the aid of a commercially available compression device. Results All osteotomies achieved complete union except in one case in the control group. The mean interval to complete cortical union was 7.7 weeks in the periosteum-preserved group and 9.5 weeks in the control group. The corresponding mean times for endosteal union were 15.6 and 21.8 weeks. The periosteum-preserved group had reduced times for both types of union but only the endosteal union time was significantly different from the control group. Conclusions Preservation of the corticoperiosteal attachment significantly shortened the endosteal union time. Our results indicate that preservation of the periosteum may accelerate bone healing after ulna-shortening osteotomy.

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Clinical, Radiographic, and Arthroscopic Outcomes After Ulnar Shortening Osteotomy: A Long-Term Follow-Up Study

Cited by 32 publications

References 31 publications

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Distal Radioulnar Joint Reaction Force Following Ulnar Shortening: Diaphyseal Osteotomy Versus Wafer Resection

Effect of Preservation of Corticoperiosteal Attachment on Bone Healing at Osteotomy Sites after Ulna-shortening Osteotomy

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