A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

Abstract

Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p<0.05) and average patient satisfaction was 8.7. DASH and PRWE scores improved at three month follow-up (p<0.05). Osteotomy healing time averaged 10.3 weeks, and there were no nonunions. Average discomfort associated with palpation of the plate at final follow-up was 3.3 (using VOS), and one patient requested removal of the hardware. In this short-term follow-up study, the assessed ulna shortening system appears effective and, in general, well tolerated.

Keywords

Ulna shortening osteotomy Ulnar abutment Triangular fibrocartilage complex tears

Get full access to this article

View all access options for this article.

References

Bernstein

Nagle

Martinez

. et al. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy. 2004;20:392–401.

Boulas

Milek

. Ulnar shortening for tears of the triangular fibrocartilaginous complex. J Hand Surg [Am]. 1990;15:415–20.

Chen

Wolfe

. Ulna shortening osteotomy using a compression device. J Hand Surg [Am]. 2003;28:88–93.

Chennagiri

Burge

. Pre-osteotomy plate application technique for ulnar shortening. J Hand Surg [Br]. 2004;29:453–7.

Chun

Palmer

. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg [Am]. 1993;18:46–53.

Constantine

Tomaino

Herndon

. et al. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg [Am]. 2000;25:55–60.

Darrow

Jr Linscheid

Dobyns

. et al. Distal ulnar recession for disorders of the distal radioulnar joint. J Hand Surg [Am]. 1985;10:482–91.

Feldon

Terrono

Belsky

. The “wafer” procedure. Partial distal ulnar resection. Clin Orthop Relat Res. 1992;275:124–9.

Hulsizer

Weiss

Akelman

. Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg [Am]. 1997;22:694–8.

10.

Lauder

Luria

Trumble

. Oblique ulnar shortening osteotomy with a new plate and compression system. Tech Hand Up Extrem Surg. 2007;11:66–73.

11.

Linscheid

. Ulnar lengthening and shortening. Hand Clin. 1987;3:69–79.

12.

Loh

Van Den Abbeele

Stanley

. et al. The results of ulnar shortening for ulnar impaction syndrome. J Hand Surg [Br]. 1999;24:316–20.

13.

Luria

Lauder

Trumble

. Comparison of ulnar-shortening osteotomy with a new Trimed dynamic compression system versus the Synthes dynamic compression system: clinical study. J Hand Surg [Am]. 2008;33:1493–7.

14.

Menon

Wood

Schoene

. et al. Isolated tears of the triangular fibrocartilage of the wrist: results of partial excision. J Hand Surg [Am]. 1984;9:527–30.

15.

Milch

. Cuff resection of the ulna for malunited Colles' fracture. J Bone Joint Surg Am. 1941;23:311–3.

16.

Minami

Kato

. Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg [Am]. 1998;23:904–8.

17.

Minami

Ishikawa

Suenaga

. et al. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg [Am]. 1996;21:406–11.

18.

Mizuseki

Tsuge

Ikuta

. Precise ulna-shortening osteotomy with a new device. J Hand Surg [Am]. 2001;26:931–9.

19.

Palmer

. The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities. Hand Clin. 1987;3:31–40.

20.

Palmer

Werner

. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg [Am]. 1981;6:153–62.

21.

Rayhack

Gasser

Latta

. et al. Precision oblique osteotomy for shortening of the ulna. J Hand Surg [Am]. 1993;18:908–18.

22.

Tatebe

Nakamura

Horii

. et al. Results of ulnar shortening osteotomy for ulnocarpal impaction syndrome in wrists with neutral or negative ulnar variance. J Hand Surg [Br]. 2005;30:129–32.

23.

Trumble

Gilbert

Vedder

. Ulnar shortening combined with arthroscopic repairs in the delayed management of triangular fibrocartilage complex tears. J Hand Surg [Am]. 1997;22:807–13.

24.

Wehbe

Cautilli

. Ulnar shortening using the AO small distractor. J Hand Surg [Am]. 1995;20:959–64.