Clin Orthop Surg.  2011 Dec;3(4):295-301. 10.4055/cios.2011.3.4.295.

Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

• Baek GH
• Lee HJ
• Gong HS
• Rhee SH
• Kim J
• Kim KW
• Kong BY
• Oh WS

• KMID: 1097167
• DOI: http://doi.org/10.4055/cios.2011.3.4.295

Abstract

BACKGROUND
There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome.
METHODS
We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined.
RESULTS
The average modified Gartland and Werley wrist score improved from 65.5 +/- 8.1 preoperatively to 93.4 +/- 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 +/- 2.0 mm was reduced to an average of -0.6 +/- 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 +/- 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ.
CONCLUSIONS
The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

Keyword

Idiopathic ulnar impaction syndrome; Ulnar shortening osteotomy; Long-term outcome; Osteoarthritis; Distal radioulnar joint

MeSH Terms

Bone Diseases/*surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
*Osteotomy
Retrospective Studies
Syndrome
Time Factors
Treatment Outcome
Ulna/*surgery

Figure

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  Fig. 1 (A) Measurement of ulnar variance (arrow) on the preoperative anteroposterior wrist radiograph. (B) Measurement of ulnar variance (arrows) on the postoperative anteroposterior wrist radiograph.

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  Fig. 2 (A) The preoperative lateral radiograph showed the measurement of the radioulnar distance (RU). The pisoscaphoid distance (PS) was used to define a true lateral radiograph of the wrist. (B) The postoperative lateral radiograph showed a decrease in the RU.

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  Fig. 3 Types of the distal radioulnar joint (DRUJ). (A) Type I: The apposing joint surfaces (b & c) are parallel to the long axis of the ulna (a). (B) Type II: The apposing joint surfaces (b & c) are oblique to the long axis of the ulna (a). The sigmoid notch and the ulnar seat angles are positive. (C) Type III: The apposing joint surfaces (b & c) are reversely oblique to the long axis of the ulna (a). The sigmoid notch and the ulnar seat angles are negative.

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  Fig. 4 (A) Positive ulnar variance was seen on the preoperative anteroposterior wrist radiograph. No osteoarthritic changes of the distal radioulnar joint (DRUJ) were seen. (B) Osteoarthritic changes of the DRUJ after a follow-up period of 44 months.

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