Stacked-blade, single-cut, ulnar-shortening osteotomy

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Bone Healing

Background:

• Chronic ulnar impaction syndrome causes significant wrist pain and dysfunction.
• Ulnar-shortening osteotomy is a surgical option to correct positive ulnar variance.
• Accurate and predictable shortening is crucial for successful outcomes.

Purpose of the Study:

• To evaluate the efficacy and predictability of a freehand, single oblique ulnar-shortening osteotomy technique.
• To assess radiographic outcomes and symptom relief in patients with chronic ulnar impaction syndrome.
• To determine the reliability of intraoperative estimations of ulnar shortening.

Main Methods:

• Review of a 10-year series of 23 ulnar-shortening osteotomies in 21 patients.
• Freehand, single oblique osteotomy using stacked saw blades in the distal ulnar diaphysis.
• Fixation with a dorsal dynamic compression plate; shortening estimated using a formula based on kerf width and osteotomy angle.

Main Results:

• Average preoperative ulnar variance of +2.1 mm corrected to -0.6 mm postoperatively.
• Average actual shortening of 2.8 mm, with an 18% variance from the intraoperative estimate.
• Radiographic union achieved in 100% of cases; ulnar-sided wrist pain relieved in 22 wrists.

Conclusions:

• The described freehand oblique ulnar-shortening osteotomy is a simple, effective, and inexpensive method for treating chronic ulnar impaction syndrome.
• The technique provides reasonably predictable ulnar shortening, with potential for application in other long bones.
• Intraoperative use of a sterile goniometer is recommended for precise osteotomy angle placement.