Ulnar Shortening With Rotational Osteotomy of the Distal Facing Sigmoid Notch for Ulnar Carpal Abutment Syndrome

Pediatric distal radius fractures with epiphyseal growth arrest can lead to ulnar positive variance and ulnar carpal abutment. In these cases, where there is an associated distally facing sigmoid (or reverse oblique sigmoid, Tolat type III), an ulna shortening osteotomy can result in incongruity of the distal radioulnar joint (DRUJ). We present a series of patients with a distally facing sigmoid who had undergone an ulna shortening osteotomy and sigmoid notch rotational osteotomy to treat the ulnar carpal abutment and adjust for the incongruity of the DRUJ.

A review of patients who had undergone sigmoid notch rotational osteotomy with ulna shortening osteotomy was performed. All patients had a history of pediatric distal radius fracture, ulnar abutment syndrome, and Tolat type III DRUJ. Data on clinical history, postoperative physical examination, visual analog scale score, Disabilities of Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and plain radiographs of both the operated and unaffected wrists were collected.

Of the 6 patients treated, 4 were available for follow-up, with an age range of 13-23 years. The mean follow-up period was 99 months (range: 66-168 months). The mean follow-up value for visual analog score pain score was 0.5. Physical examination demonstrated a similar range of motion and grip strength of both the operated and unaffected wrists. Plain film radiography confirmed union of all osteotomy sites and reversal of the sigmoid notch angle, matching the ulnar seat angle.

Ulna shortening with sigmoid notch rotationplasty is an effective option to relieve the symptoms from ulnar carpal abutment associated with a distally facing sigmoid.

Therapeutic V.