Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

Abstract

Background Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence Therapeutic III.

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

“…We reviewed electronic patient records to confirm that the USO was performed for UIS, as USO may also be used for other indications. As in our previous study, 12 at least one of the following criteria needed to be met to be included in the study: 1) the surgeons explicitly diagnosed the patients with UIS in the electronic patient records; 2) wrist arthroscopy showed signs of type 2 lesions, such as triangular fibrocartilage complex (TFCC) degeneration and lunate chondropathy, according to Palmer; 19 3) magnetic resonance imaging (MRI) showed signs of focal abnormal signal intensity in the lunate, triquetrum, and ulnar head; 20 and 4) there was evident static or dynamic ulnar positive variance on standard posterior-anterior wrist radiographs in a neutral position. 21 This definition excluded three patients that underwent USO for other indications.…”

“…The nonunion rate in our study sample was relatively high compared to our previous study (12% vs 6%) and the pooled estimate from the meta-analysis by Owens et al 40 (4%). 12 We could not find the cause for a higher incidence in our study as multiple prognostic factors for nonunion after USO, such as bone density and ROM, were not measured. 41 We observed that patients who experienced a nonunion (subsequently treated) had an impaired functional outcome at 12 months, but this difference disappeared at late follow-up.…”

“…The routine postoperative immobilization protocol has been described before. 12 The entire postoperative protocol is shown in Supplementary Material table i. Our hand surgery and therapy centre are fully integrated, and postoperative hand therapy was closely monitored.…”

“…[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). 11,12 While shortterm outcomes are favourable, long-term PROMs beyond one year after USO are barely reported. 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.…”

Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)

“…A case series involving 106 patients indicates that early long-arm plaster fixation can effectively reduce rotational stress on the fracture ends, promoting fracture healing. 84 This involves wearing a long-arm plaster for the first 2 weeks and a long-arm thermoplastic orthosis for the next 2 to 4 weeks, with wrist flexion/extension exercises starting from the 2nd week and forearm rotation exercises starting after the 6th week. Refixation was performed in six patients (6%) because of nonunion.…”