Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures.

A malunited distal radius fracture can lead to symptomatic ulnar impaction syndrome, which is a common cause for ulnar-sided wrist pain. If conservative treatment fails and symptoms persist after an arthroscopic ulnocarpal debridement, ulnar shortening osteotomy (USO) is the treatment of choice. Since the first USO described by Milch in 1941 after a malunited Colles fracture, many techniques have been described varying in surgical approach, type of osteotomy and osteosynthesis material used. Many studies demonstrated good to very good functional results after USO, reporting, however, a delayed union or non-union rate up to 18%. A modern, low profile, locking plate showed in our short-term study very good functional results and no implant-associated complications, in particular no non-union.

[Surgical treatment of ulnar impaction syndrome : Ulnar shortening osteotomy through the ulnopalmar approach using a low-profile, locking plate]. / Die operative Behandlung des Ulna-Impaction-Syndroms : Ulnaverkürzungsosteotomie mit einer winkelstabilen, Low-profile-Platte über einen ulnopalmaren Zugang.

OBJECTIVE: Extra-articular shortening of the distal ulna in order to decompress the ulnocarpal joint. INDICATIONS: Congenital or posttraumatic, symptomatic ulnar impaction syndrome. CONTRAINDICATIONS: Osteoarthritis or deformation of the distal radioulnar joint. SURGICAL TECHNIQUE: Exactly defined oblique osteotomy in the distal third of the ulna using the saw guide, closing of the osteotomy gap using the compression spindle, osteosynthesis with the locking plate. POSTOPERATIVE MANAGEMENT: Palmar forearm thermoplastic cast or splint for 3 weeks, load bearing after bony union. RESULTS: Between June 2016 and March 2018 ulnar shortening was performed in 17 patients using the new locking plate. In all, 15 patients were reevaluated with complete follow-up data. Postoperatively patients experienced significant pain reduction (Visual Analog Scale 0-10) by 65% (7 before and 2.5 after surgery; p < 0.05) and a significant improvement of function (Disabilities of Arm, Shoulder and Hand 0-100) by 49% (47 before and 24 after surgery; p < 0.05). Bony union was observed in all patients after a mean time of 4 months. Overall patient satisfaction was high.