The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients

Abstract

Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method.

Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist.

Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws.

Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the non-operated side.

Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

Keywords

ulnocarpal abutment - ulnar shortening - oblique metaphyseal osteotomy - headless compression screw

Note

This study received the approval of the Leading Ethics Committee number 1755 of the AZ Sint–Jan AV Brugge–Oostende, campus Brugge, Brugge, Belgium.

• References

• 1 Fricker R, Pfeiffer KM, Troeger H. Ulnar shortening osteotomy in posttraumatic ulnar impaction syndrome. Arch Orthop Trauma Surg 1996; 115 (3–4) 158-161
• 2 Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg Am 1982; 7 (4) 376-379
• 3 Cerezal L, del Piñal F, Abascal F, García-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002; 22 (1) 105-121
• 4 Tomaino MM, Elfar J. Ulnar impaction syndrome. Hand Clin 2005; 21 (4) 567-575
• 5 Kristensen SS, Thomassen E, Christensen F. Ulnar variance determination. J Hand Surg [Br] 1986; 11 (2) 255-257
• 6 Jung JM, Baek GH, Kim JH, Lee YH, Chung MS. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 2001; 83 (7) 1029-1033
• 7 Schuind FA, Linscheid RL, An KN, Chao EY. A normal data base of posteroanterior roentgenographic measurements of the wrist. J Bone Joint Surg Am 1992; 74 (9) 1418-1429
• 8 Darrach W. Partial excision of lower shaft of ulna for deformity following Colles's fracture. 1913. Clin Orthop Relat Res 1992; (275) 3-4
• 9 Watson HK, Ryu JY, Burgess RC. Matched distal ulnar resection. J Hand Surg Am 1986; 11 (6) 812-817
• 10 Katz DI, Seiler III JG, Bond TC. The treatment of ulnar impaction syndrome: a systematic review of the literature. J Surg Orthop Adv 2010; 19 (4) 218-222
• 11 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (2) 295-310
• 12 Feldon P, Terrono AL, Belsky MR. The “wafer” procedure. Partial distal ulnar resection. Clin Orthop Relat Res 1992; (275) 124-129
• 13 Markolf KL, Tejwani SG, Benhaim P. Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study. J Hand Surg Am 2005; 30 (2) 351-358
• 14 Greenberg JA, Werner FW, Smith JM. Biomechanical analysis of the distal metaphyseal ulnar shortening osteotomy. J Hand Surg Am 2013; 38 (10) 1919-1924
• 15 Nishiwaki M, Nakamura T, Nagura T, Toyama Y, Ikegami H. Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg Am 2008; 33 (2) 198-205
• 16 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (1) 46-53
• 17 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (6) 719-723
• 18 Milch H. Cuff resection of the ulna for malunited Colles' fracture. J Bone Joint Surg Am 1941; 23(2): 311-313
• 19 Slade 3rd JF, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg 2007; 11 (1) 74-82
• 20 Hammert WC, Williams RB, Greenberg JA. Distal metaphyseal ulnar-shortening osteotomy: surgical technique. J Hand Surg Am 2012; 37 (5) 1071-1077
• 21 Lauder AJ, Luria S, Trumble TE. Oblique ulnar shortening osteotomy with a new plate and compression system. Tech Hand Up Extrem Surg 2007; 11 (1) 66-73
• 22 Rayhack JM, Gasser SI, Latta LL, Ouellette EA, Milne EL. Precision oblique osteotomy for shortening of the ulna. J Hand Surg Am 1993; 18 (5) 908-918
• 23 Barry JA, Macksoud WS. Cartilage-retaining wafer resection osteotomy of the distal ulna. Clin Orthop Relat Res 2008; 466 (2) 396-401
• 24 Vandenberghe L, Degreef I, Didden K, Moermans A, Koorneef P, De Smet L. Ulnar shortening or arthroscopic wafer resection for ulnar impaction syndrome. Acta Orthop Belg 2012; 78 (3) 323-326
• 25 Wnorowski DC, Palmer AK, Werner FW, Fortino MD. Anatomic and biomechanical analysis of the arthroscopic wafer procedure. Arthroscopy 1992; 8 (2) 204-212
• 26 Yin HW, Qiu YQ, Shen YD, Xu JG, Gu YD, Xu WD. Arthroscopic distal metaphyseal ulnar shortening osteotomy for ulnar impaction syndrome: a different technique. J Hand Surg Am 2013; 38 (11) 2257-2262
• 27 Sennwald G, Della Santa D. The step-cut shortening osteotomy of the shaft of the ulna, technique and results [article in French]. Chir Main 2006; 25 (3–4) 136-140
• 28 Sennwald G, Della Santa D, Beaulieu JY. A comparison of diaphyseal and metaphyseal techniques of ulna shortening. J Hand Surg Eur Vol 2013; 38 (5) 542-549
• 29 Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am 2000; 25 (1) 55-60
• 30 Pechlaner S. Dekompressionsosteotomie des ellenkopfes bei impingementbeschwerden im ulnaren handgelenkkompartiment. Oper Orthop Traumatol 1995; 7: 164-174
• 31 Lautenbach M, Millrose M, Schmidt NS, Zach A, Eichenauer F, Eisenschenk A. Ulnocarpal impaction syndrome: treatment with a transverse ulnar shortening osteotomy from an ulnodorsal approach. Arch Orthop Trauma Surg 2014; 134 (6) 881-885
• 32 Khouri JS, Hammert WC. Distal metaphyseal ulnar shortening osteotomy: technique, pearls, and outcomes. J Wrist Surg 2014; 3 (3) 175-180
• 33 Horn PC. The long ulnar sliding osteotomy. J Hand Surg Am 2004; 29 (5) 871-876
• 34 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
• 35 Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. J Bone Joint Surg Am 2005; 87 (12) 2649-2654
• 36 Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. Surgical technique. J Bone Joint Surg Am 2006; 88 (Suppl 1 Pt 2): 212-220