What is the long-term outcome of ulnar shortening osteotomy?

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Ulna shortening osteotomy is an established treatment method for treating patients with ulnar impingement syndrome. Previous studies have shown good results based on X-rays and clinical studies, but there are few studies that evaluate results based on satisfaction and quality of life questionnaires answered by patients.

Also read: Fixation of 1 or 2 forearm bones in pediatric radial and ulna diaphyseal fractures?

a job with follow up 6 months showed good functioning and pain results with the PRWHE questionnaire (Patient-assessed wrist and hand evaluation) answered by 106 patients after ulnar shortening osteotomy, but data on these long-term results are even scarcer. It was published in the magazine last month Bone and joints open a study with the main purpose of examining such results with a follow up bigger. The secondary objectives were to assess satisfaction with the procedure, complications and the need for further surgery.

What are the long-term results of ulnar shortening osteotomy?

The study

A prospective cohort study was developed with 106 patients from some Dutch hospitals operated between 2011 and 2017. All osteotomies were inclined, performed at the level of the distal diaphysis and performed either freehand or with an external cutting device according to the surgeon’s preference. ulnar influence as an indication. The mean shortening was 4 mm and was based on preoperative ulnar variation. The ulna is fixed with a compression plate and screws or with a specific system for the ulna.

Age, sex, type of work, duration of symptoms, side of treatment, hand dominance and smoking at the time of surgery were routinely recorded. The charts were reviewed to collect data on treatment of the initial injury, operative variables, incidence of complications, and subsequent treatment. Patients also received the Dutch version of PRWHE to evaluate surgical outcomes.

Long-term results were available in 66 patients (74%) after a mean late follow-up of six years (SD = 1). The mean overall PRWHE score improved from 63 before surgery to 19 at late follow-up (mean difference (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12-month and later follow-up, the overall PRWHE score also improved (Δ 12; 95% CI 6 to 18; p = <0.001).

Find out more: In situ maintenance or anterior transposition of the ulnar nerve by surgical treatment of bilunar fractures in the distal third of the humerus?

At subsequent follow-up, 14/66 patients (21%) reported an overall PRWHE score of zero, whereas this was 3/51 patients (6%) after 12 months (p = 0.039). In total, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms was performed in 50/66 patients (76%). The most common type of reoperation was hardware removal in 42/66 (64%), and pseudarthrosis occurred in 8/66 (12%).

In practice

Ulna-shortening osteotomy improved patient-reported pain and function even in the long term. While the level of satisfaction is generally high, reoperations such as hardware removal common. In addition, it is also important to remember that for cases of ulna plus less than 4 mm, the arthroscopic wafer procedure is also a good option for these patients, also with good results and a low number of complications.

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# Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B; Contributors of the wrist study group. Long-term results after ulna-shortening osteotomy: an average follow-up of six years. Bone Jt Open. May 2022; 3 (5): 375-382. doi: 10.1302 / 2633-1462.35.BJO-2022-0031.R1.

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