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. 2014 May;3(2):77-84.
doi: 10.1055/s-0034-1372516.

Ulnar shortening osteotomy for ulnar-sided wrist pain

Masahiro Tatebe  1 , Takanobu Nishizuka  2 , Hitoshi Hirata  2 , Ryogo Nakamura  3
Affiliations

Ulnar shortening osteotomy for ulnar-sided wrist pain

Masahiro Tatebe et al. J Wrist Surg. 2014 May.

Abstract

Background 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.

Keywords: DRUJ; TFCC; arthroscopy; ulnar shortening osteotomy; ulnar-sided wrist pain.

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Conflict of interest statement

Conflict of interest None

Figures

Fig. 1
Fig. 1
Treatment algorithm for ulnar wrist pain. USO: ulnar shortening osteotomy, TFCC: triangular fibrocartilage complex, DRUJ: distal radioulnar joint. Cartilage grade: Grade I, chondromalacia, with or without swelling; Grade II, superficial fissures and erosions that do not reach subchondral bone; Grade III, deep fissures, down to subchondral bone; Grade IV, exposure of subchondral bone.
Fig. 2
Fig. 2
Radiological evaluation. Ulnar variance (UV) was determined using the “project-a-line” technique. Ulnar head inclination is the angle between the longitudinal shaft of the ulna and the tangent to the ulnar head. Sigmoid notch inclination is the angle between the longitudinal shaft of the ulna and the tangent to the sigmoid notch of the radius. Sigmoid notch length is indicated by arrows. Length of shortening = preoperative UV – postoperative UV.
Fig. 3
Fig. 3
Pre- and postoperative X-rays. A 5-hole AO tensioning-compression plate was used.
Fig. 4
Fig. 4
Bony spur at DRUJ pre-operatively and at 4, 10, 24 and 36 months postoperatively.
See this image and copyright information in PMC

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