Arch Hand Microsurg.  2022 Dec;27(4):279-284. 10.12790/ahm.22.0054.

Comparison of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome using conventional or ulnar osteotomy plates and with or without interfragmentary screw fixation

• Kim KW
• Kim JH
• Kim JS
• Shin BJ
• Kim JP

• KMID: 2536212
• DOI: http://doi.org/10.12790/ahm.22.0054

Abstract

Purpose
This study investigated the impact of plate type on the clinical and radiological outcomes of ulnar shortening osteotomy (USO) by comparing conventional and ulnar osteotomy plates. The effect of interfragmentary screw fixation (ISF) during USO was also assessed.
Methods
Seventy-eight patients were divided into three groups according to the type of plate: 3.5-mm dynamic compression plate (DCP), 3.5-mm limited contact DCP, and 2.7-mm locking compression plate ulna osteotomy system (all from Depuy-Synthes). The patients were also divided into two groups according to whether ISF was performed. Clinical and radiological outcomes, including time to bone union, presence of delayed union, and refracture after hardware removal, were analyzed. Other factors that might affect bone union, such as smoking and underlying diseases, were also evaluated.
Results
No significant differences were found in clinical and radiological outcomes according to the type of plate. Eight of 51 patients (15.7%) in the without-ISF group showed delayed bone union. Forty-three patients in the without-ISF group underwent hardware removal, and refracture due to low-energy trauma after hardware removal was observed in five of those 43 patients (11.6%). Bone union time was significantly shorter in the with-ISF group (7.6±2.7 weeks vs. 9.8±6.6 weeks). Diabetes mellitus and ISF were associated with the delayed bone union.
Conclusion
The plate type had no influence on the clinical and radiological outcomes of USO in patients with idiopathic ulnar impaction syndrome. However, ISF during USO has several advantages, such as early bony union and prevention of refracture after hardware removal.

Keyword

Ulnar impaction syndrome; Ulnar shortening osteotomy; Interfragmentary screw; Bone union time; Refracture

Figure

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  Fig. 1. (A) A 62-year-old man was treated with a 2.7-mm locking compression plate (LCP) ulna osteotomy system (Depuy-Synthes, West Chester, PA, USA), and interfragmentary screw fixation was not performed. Immediately postoperatively, a neutral ulnar variance was achieved and the ulnar osteotomy plate settled well. (B) Twelve weeks later, the gap at the osteotomy site had increased, and delayed bone union occurred. (C) Twenty-four weeks later, radiological bone union was spontaneously achieved. (D) A 59-year-old man was treated with a 2.7-mm LCP ulna osteotomy system (Depuy-Synthes), and interfragmentary screw fixation was not performed. (E) Thirteen weeks later, callus formation was seen around the osteotomy site. (F) Twenty-six weeks later, radiological bone union was achieved with excessive callus formation.

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  Fig. 2. (A) A 49-year-old woman underwent ulnar shortening osteotomy without interfragmentary screw fixation. Eleven months later, solid bone union was achieved and hardware removal was done. (B) Refracture occurred by low-energy trauma after hardware removal. (C) A revisional operation was done with ulnar osteotomy plate and interfragmentary screw fixation was performed. Seven weeks later, solid bone union was achieved. (D) A 29-year-old man underwent ulnar shortening osteotomy without interfragmentary screw fixation. Twelve months later, solid bone union was achieved and hardware removal was performed. (E) After hardware removal, refracture by low-energy trauma occurred. (F) Revisional closed reduction and intramedullary nail fixation were performed. Nine weeks later, solid bone union was achieved.

Reference

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