The Effect of Early Active Mobilization on Union Rate after Ulnar Shortening OsteotomyFunding None.
30 August 2018
24 September 2018
31 October 2018 (online)
Background Ulnocarpal impaction occurs when there is excessive loading between the ulnar carpus and the distal ulna. Ulnar shortening osteotomies (USOs) decompress the ulnocarpal joint. Many studies have evaluated USO but none have considered the effect of early active mobilization on union rate.
Questions Does early active mobilization affect rate of union following USO? Does early active mobilization affect rate of complications following USO?
Patients and Methods We performed a retrospective review of 15 consecutive patients that underwent 16 USOs between 2011 and 2015. There were seven males and eight females. Median age at time of shortening osteotomy was 47 years (range: 11–63 years). The median time of the procedure was 62 minutes (range: 45–105 minutes) and the median change in ulnar variance was 5.5 mm (range: 0–10.5 mm). Six patients were initially immobilized in incomplete plaster casts postoperatively, while the remainder had only wool and crepe dressings. Early active mobilization commenced after the first postoperative visit at 12 days.
Results There was a 100% union rate in our series and 12 patients were pain-free at final follow-up. However, three of the patients with the longest times to union were smokers. Additionally, some patients may have achieved union between follow-up clinic visits.
Conclusion Early active mobilization after USO does not affect union rate. Prospective, randomized studies are required to investigate the effect of early active mobilization in light of factors known to increase time to union, such as smoking.
Level of Evidence This is a Level IV, case series.
This study was conducted as a service evaluation.
- 1 Stockton DJ, Pelletier ME, Pike JM. Operative treatment of ulnar impaction syndrome: a systematic review. J Hand Surg Eur Vol 2015; 40 (05) 470-476
- 2 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (02) 295-310
- 3 Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy. J Hand Surg [Br] 1998; 23 (06) 754-757
- 4 Doherty C, Gan BS, Grewal R. Ulnar shortening osteotomy for ulnar impaction syndrome. J Wrist Surg 2014; 3 (02) 85-90
- 5 Smet LD, Vandenberghe L, Degreef I. Ulnar impaction syndrome: ulnar shortening vs. arthroscopic wafer procedure. J Wrist Surg 2014; 3 (02) 98-100
- 6 Rajgopal R, Roth J, King G, Faber K, Grewal R. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (NY) 2015; 10 (03) 535-540
- 7 Das De S, Johnsen PH, Wolfe SW. Soft tissue complications of dorsal versus volar plating for ulnar shortening osteotomy. J Hand Surg Am 2015; 40 (05) 928-933
- 8 Schmidle G, Kastenberger T, Arora R. Time-dependent recovery of outcome parameters in ulnar shortening for positive ulnar variance: a prospective case series. Hand (NY) 2018; 13 (02) 215-222
- 9 Iwatsuki K, Tatebe M, Yamamoto M, Shinohara T, Nakamura R, Hirata H. Ulnar impaction syndrome: incidence of lunotriquetral ligament degeneration and outcome of ulnar-shortening osteotomy. J Hand Surg Am 2014; 39 (06) 1108-1113
- 10 Papatheodorou LK, Baratz ME, Bougioukli S, Ruby T, Weiser RW, Sotereanos DG. Long-term outcome of step-cut ulnar shortening osteotomy for ulnar impaction syndrome. J Bone Joint Surg Am 2016; 98 (21) 1814-1820
- 11 Cha S-M, Shin H-D, Kim K-C. Positive or negative ulnar variance after ulnar shortening for ulnar impaction syndrome: a retrospective study. Clin Orthop Surg 2012; 4 (03) 216-220
- 12 Fulton C, Grewal R, Faber KJ, Roth J, Gan BS. Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome. Can J Plast Surg 2012; 20 (01) e1-e5
- 13 Clark SM, Geissler WB. Results of ulnar shortening osteotomy with a new plate compression system. Hand (NY) 2012; 7 (03) 281-285
- 14 Tatebe M, Nishizuka T, Hirata H, Nakamura R. Ulnar shortening osteotomy for ulnar-sided wrist pain. J Wrist Surg 2014; 3 (02) 77-84
- 15 Viswanath P, Monaco NA, Lubahn JD. Patient-related factors influencing ulnar-shortening osteotomy outcomes using the trimed dynamic compression plate. Orthopedics 2015; 38 (02) e106-e111
- 16 Renfree KJ, Odgers RA. Stacked-blade, single-cut, ulnar-shortening osteotomy. Orthopedics 2015; 38 (02) e80-e87
- 17 Chan SK, Singh T, Pinder R, Tan S, Craigen MA. Ulnar shortening osteotomy: are complications under reported?. J Hand Microsurg 2015; 7 (02) 276-282
- 18 NRESEC e-group. Differentiating audit, service evaluation and research. 2007 . Available at: http://www.pi.nhs.uk/data/consent/NRES_leaflet_Defining_Research.pdf . Accessed October 17, 2018
- 19 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14 (04) 607-612
- 20 Gaspar MP, Kane PM, Zohn RC, Buckley T, Jacoby SM, Shin EK. Variables prognostic for delayed union and nonunion following ulnar shortening fixed with a dedicated osteotomy plate. J Hand Surg Am 2016; 41 (02) 237-243
- 21 Cha SM, Shin HD, Ahn KJ. Prognostic factors affecting union after ulnar shortening osteotomy in ulnar impaction syndrome: a retrospective case-control study. J Bone Joint Surg Am 2017; 99 (08) 638-647
- 22 Fufa DT, Carlson MG, Calfee RP, Sriram N, Gelberman RH, Weiland AJ. Mid-term results following ulna shortening osteotomy. HSS J 2014; 10 (01) 13-17
- 23 Dacombe PJ, Amirfeyz R, Davis T. Patient-reported outcome measures for hand and wrist trauma: is there sufficient evidence of reliability, validity, and responsiveness?. Hand (NY) 2016; 11 (01) 11-21
- 24 Kim JK, Park ES. Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res 2013; 471 (05) 1406-1411