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. 2023;11(11):677-683.
doi: 10.22038/ABJS.2023.73837.3418.

Nonunion After Using Procedure-Specific Instrumentations for Ulnar Shortening Osteotomy

Alexis A Kasper  1 , Yashas Reddy  1 , Kyle Plusch  1 , Alexander Adams  1 , Pedro K Beredjiklian  1 , Amir R Kachooei  2
Affiliations

Nonunion After Using Procedure-Specific Instrumentations for Ulnar Shortening Osteotomy

Alexis A Kasper et al. Arch Bone Jt Surg. 2023.

Abstract

Objectives: The primary purpose of this study was to compare the rates of nonunion among different osteotomy designs (company brand) and the rates of nonunion between oblique and transverse osteotomies. We secondarily aimed to assess the differences in reoperation and hardware removal rates after ulnar shortening osteotomy (USO).

Methods: A retrospective cohort study of patients undergoing ulnar shortening osteotomy between 2015 and 2022 in our institute amongst 17 providers resulted in 92 consecutive patients. We included skeletally mature patients who underwent USO for the ulnar impingement abutment diagnosis. Demographic information was collected, including age, gender, race/ethnicity, BMI, and medical comorbidities. Six brand-specific devices were used and compared to the conventional plate fixation. Nonunion was determined based on the final available radiograph with a minimum follow-up of four months.

Results: Of the 92 patients, 83 (90%) had a bone union. There is a remarkable difference in union among implant brands, although statistical analysis was not performed due to the small number of patients in each group. Transverse osteotomy was significantly related to a higher nonunion rate. Out of nine patients with resultant nonunion (10%), three healed after revision surgery (3.2%), two were lost to follow-up (2.2%), and four remained asymptomatic despite radiographic nonunion (4.6%). Plate removal was performed in four patients (4.3%), all of whom were in the union group.

Conclusion: Patients should be informed about the nonunion rate with possible subsequent secondary surgery. Using procedure-specific devices may have mitigated the risk of nonunion.

Keywords: Hand; Instrumentation systems; Osteotomy; Outcomes; Procedure-specific; Ulnar.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
A: Immediate postop radiograph using LC-DCP and transverse freehand ulnar osteotomy in a 50-year-old female/B: Follow-up radiograph after 17 months showing nonunion
Figure 2
Figure 2
A: Immediate postop radiograph using Rayhack system with oblique osteotomy in a 40-year-old female/ B: Follow-up radiograph after 4 months showing nonunion
Figure 3
Figure 3
A: Immediate postop radiograph using Skeletal Dynamics system with transverse osteotomy in a 55-year-old Male / B: Follow-up radiograph after 8 months showing nonunion
Figure 4
Figure 4
A: Immediate postop radiograph using Synthes system with transverse osteotomy in a 55-year-old Male / B: Follow-up radiograph after 6 months showing nonunion
Figure 5
Figure 5
A: Immediate postop radiograph using TriMed system with oblique osteotomy in a 69-year-old Male / B: Follow-up radiograph after 4 months showing nonunion
See this image and copyright information in PMC

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