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

Abstract

Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there has been a concern of osteoarthritis (OA) developing at the distal radioulnar joint (DRUJ) if USO is 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 our patients with a reverse oblique sigmoid notch who underwent USO to treat ulnar impaction syndrome between 2002 and 2013. We evaluated the radiographic changes of the DRUJ and the patients’ functional outcomes.Results: We enrolled 22 patients (22 wrists) with an average age at operation of 49.6 years and mean follow-up of 93.2 (range, 36 - 179; SD 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average of reverse oblique 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-ups. The functional results at the final follow-ups were good with a mean VAS 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%) were noted to have OA changes, 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 those patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle would have a tendency to become more parallel and some patients would develop OA changes at the DRUJ, but the functional outcomes could still be good in the long term. The reverse oblique sigmoid inclination seems not to be an absolute contraindication for USO.

Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years

“…De Runz et al 5 found that patients with DRUJ osteoarthritis had worse PRWHE scores than patients without, 5 and other studies suggested that the DRUJ morphology affected the outcome. 4,6,7 However, this study did not have radiological data at late follow-up, and DRUJ morphology could not reliably be assessed. Future prospective studies should further investigate predictors for the long-term patient-reported outcome after USO.…”

“…Ulna shortening osteotomy (USO) is an established treatment option for patients with ulnar impaction syndrome (UIS). [1][2][3] Previous studies reported good results, but mainly focused on radiological outcomes [4][5][6][7] or clinician-reported outcome measures. 4 However, these studies often lacked patientreported outcome measures (PROMs), preoperative measurements, 5 or had a small sample size.…”

“…[1][2][3] Previous studies reported good results, but mainly focused on radiological outcomes [4][5][6][7] or clinician-reported outcome measures. 4 However, these studies often lacked patientreported outcome measures (PROMs), preoperative measurements, 5 or had a small sample size. [8][9][10] Our previous study on 106 patients found beneficial outcomes in patient-reported pain and function 12 months after USO, measured with the Patient-Rated Wrist and Hand Evaluation (PRWHE).…”

“…However, we need to know whether short-term outcomes are sustainable at late follow-up as USO realigns the distal radioulnar joint (DRUJ) and changes the multidirectional status of the joint, 13 and multiple studies have reported osteoarthritic changes at long-term follow-up. 4,5,14,15 For example, De Runz et al 5 found that 63% of the patients had worsening or developing distal radioulnar joint osteoarthritis (DRUJ OA) at a mean follow-up of five years (1 to 10) after USO. As DRUJ OA can result in symptoms that might require subsequent treatment (such as DRUJ arthroplasty), it is crucial to know whether patients still benefit from USO after long-term follow-up or whether outcomes decline.…”