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. 2021 Feb 3;22(1):136.
doi: 10.1186/s12891-021-04029-7.

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

Hui-Kuang Huang  1   2   3   4 , Steve K Lee  5 , Yi-Chao Huang  1   2 , Cheng-Yu Yin  1   2   6 , Ming-Chau Chang  1   2 , Jung-Pan Wang  7   8
Affiliations

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

Hui-Kuang Huang et al. BMC Musculoskelet Disord. .

Abstract

Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was 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 patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients.

Results: We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36-179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 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-up. The functional results at the final follow-up were good, with a mean visual analogue scale 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%) had changes compatible with OA, 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 patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.

Keywords: Oblique; Reverse; Sigmoid notch; Ulnar impaction; Ulnar shortening.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
DRUJ Tolat types. a. Type 1, parallel: the sigmoid notch is parallel to the long axis of the ulna within ±10°; b. Type 2, oblique: the sigmoid notch has an oblique angle facing proximally > 10°; c. Type 3, reverse oblique: the sigmoid notch has a reverse oblique angle facing distally > 10
Fig. 2
Fig. 2
A 27-year-old male patient. a. Radiograph of the left wrist before USO showing the reverse oblique sigmoid notch; b. Radiograph at the 36-month follow-up after surgery. The bony inclination of the sigmoid notch had become more parallel
See this image and copyright information in PMC

References

    1. Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg [Am] 2005;30(4):719–726. doi: 10.1016/j.jhsa.2005.04.015. - DOI - PubMed
    1. Papapetropoulos PA, Wartinbee DA, Richard MJ, Leversedge FJ, Ruch DS. Management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening osteotomy. J Hand Surg [Am] 2010;35(10):1607–1613. doi: 10.1016/j.jhsa.2010.06.015. - DOI - PubMed
    1. Baek GH, Lee HJ, Gong HS, et al. Long-term outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up. Clin Orthop Surg. 2011;3(4):295–301. doi: 10.4055/cios.2011.3.4.295. - DOI - PMC - PubMed
    1. Mirza A, Mirza JB, Shin AY, Lorenzana DJ, Lee BK, Izzo B. Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy. J Hand Surg [Am] 2013;38(8):1492–1497. doi: 10.1016/j.jhsa.2013.05.024. - DOI - PubMed
    1. Tatebe M, Nishizuka T, Hirata H, Nakamura R. Ulnar shortening osteotomy for ulnar-sided wrist pain. J Wrist Surg. 2014;3(2):77–84. doi: 10.1055/s-0034-1372516. - DOI - PMC - PubMed