J Wrist Surg 2019; 08(05): 352-359
DOI: 10.1055/s-0038-1677494
Special Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Distal Ulnar Metaphyseal Wedge Osteotomy for Ulnar Abutment Syndrome

Nobuyuki Kubo
1  Department of Orthopaedic Surgery, Kyouritsu Hospital, Kawanishi-shi, hyogo, Japan
Hisao Moritomo
2  Osaka Yukioka College of Health Science, Yukioka Hospital Hand Center, Osaka-shi, Osaka, Japan
Sayuri Arimitsu
3  Department of Orthopaedic Surgery, Yukioka Hospital, Osaka, Osaka Prefecture, Japan
Shunsuke Nishimoto
4  Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki-shi, Hyogo, Japan
Takeshi Yoshida
5  Yoshida Orthopaedic Clinic, Itami-shi, Hyogo, Japan
› Author Affiliations
Further Information

Publication History

23 October 2017

26 November 2018

Publication Date:
06 February 2019 (online)


Background Ulnar shortening osteotomy of the diaphysis is a common and effective surgical procedure for ulnar abutment syndrome. However, this procedure has some disadvantages, such as a long period until union and a relatively high nonunion rate. To overcome these disadvantages, we have developed distal ulnar metaphyseal wedge osteotomy. The purpose of this article is to describe the technique and to report its clinical results.

Patients and Methods Distal ulnar metaphyseal wedge osteotomy consists of resection of the wedge fragment at the distal ulnar metaphysis, compressing the distal fragment of the ulna toward the radial–proximal direction and fixation with a Herbert type headless screw. We performed this procedure for 58 patients with ulnar abutment syndrome, and the clinical data of 43 patients who were followed for > 6 months were analyzed. We evaluated range of motion, grip strength, and HAND20 which is a validated subjective scoring system in Japan.

Results All patients experienced relief from their ulnar wrist pain, and bone union was achieved within an average of 2.6 months. The range of dorsiflexion improved from 63° preoperatively to 69° postoperatively, grip strength compared with the contralateral hand improved from 77% preoperatively to 87% postoperatively, and HAND20 improved from 41.3 points preoperatively to 22.4 points postoperatively.

Discussion This procedure has advantages especially in early bone union. This procedure should be taken into consideration as one of the options to treat ulnar abutment syndrome.